Endosonography-guided, fine-needle aspiration cytology extending the indication for organ-preserving pancreatic surgery

OBJECTIVE: Organ preserving pancreatic resections are considered whenever m alignant disease is ruled out. In tamers of low malignant potential such as cystadenomas and neuroendocrine tumors, the diagnosis is rarely establishe d pre operatively. We studied the feasibility of cytodiagnosis using endoso nography-guided fine-needle aspiration in determining the operative approac h. METHODS: A total of 78 patients (16 female, 62 male; mean age 61.4 yr, rang e 31-82 yr) with focal pancreatic lesions underwent EUS-FNA. Final diagnosi s was confirmed by histology, cytology, or clinical follow up (>9 months). Patients with tumors of low malignant potential were managed by customized pancreatic resections. RESULTS: Final diagnosis was malignant tumors in 36 patients, tumors of low malignant potential in nine (six, neuroendocrine, two, borderline mucinous cystadenomas, one, borderline adenocarcinoma), and benign in 31 (two inade quate smears). No complications occurred. With six false negative and no fa lse-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 92%, 84%, 100%, 100%, and 86%, respecti vely. Five patients with low malignant tumors underwent duodenum-preserving pancreatic head resection, three mid segment resection, and one pylorus-pr eserving pancreatoduodenectomy. CONCLUSIONS: EUS-FNA is useful in the preoperative cytodiagnosis of pancrea tic tumors of low malignant potential. It extends the indication for organ- preserving pancreatic resections and avoids the unnecessary sacrifice of ad jacent organs. (Am J Gastroenterol 2000;95:2255-2260. (C) 2000 by Am. Coll. of Gastroenterology).