Endoscopic ultrasound-guided fine needle aspiration of the pancreas

Diagnostic utility and accuracy

Alaa M Afify, Basim M. Al-Khafaji, Byungki Kim, James M. Scheiman

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is regarded as a safe and reliable procedure for diagnosing and staging of pancreatic neoplasms. This study retrospectively evaluated both the diagnostic utility and accuracy of pancreatic EUS-FNABs and potential cytologic pitfalls when using Diff-Quik® stain for on-site evaluation. STUDY DESIGN: Pancreatic EUS-FNABs performed between 1995 and 1998 were identified from the files of the Department of Pathology. All patients were studied via a linear-array ultrasound endoscope with an FNAB device. Immediate evaluation of the specimen by a pathologist using air-dried slides and Diff-Quik® stain was done on all cases. An average of five passes (range, three to nine) were performed. Five cytologic categories were identified: nondiagnostic, benign, atypical, suspicious and malignant. EUS disease staging, histologic correlation and clinical follow-up were reviewed. RESULTS: Sixty-nine consecutive pancreatic FNABs were evaluated in the study period. The patients comprised 38 females and 31 males with a mean age of 65 years (range, 36-83). Histologic correlation was available on 40 patients, and followup was available on the remaining 29. The cytologic diagnoses included: 31 malignant, 8 suspicious, 6 atypical, 20 benign and 4 nondiagnostic. Forty-three cases were true positive, 9 were true negative, 2 were false positive, and 11 were false negative. The overall sensitivity was 80% and specificity was 82%. CONCLUSION: The study showed that cytologic evaluation of pancreatic EUS-FNABs has 80% sensitivity and 82% specificity. False negative diagnosis was usually due to sampling error. A nondiagnostic cytologic diagnosis should be rendered in the absence of adequate sampling of a lesion. On-site cytologic evaluation of EUSFNABs aids in guaranteeing specimen adequacy, and the pathologist should be trained to evaluate Diff Quik®-stained samples.

Original languageEnglish (US)
Pages (from-to)341-348
Number of pages8
JournalActa Cytologica
Volume47
Issue number3
StatePublished - 2003
Externally publishedYes

Fingerprint

Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreas
Selection Bias
Endoscopes
Fine Needle Biopsy
Pancreatic Neoplasms
Air
Pathology
Sensitivity and Specificity
Equipment and Supplies
Diff Quik
Pathologists

Keywords

  • Aspiration biopsy
  • Endoscopy, gastrointestinal
  • Pancreatic cancer
  • Pancreatic diseases
  • Pancreatic neoplasms

ASJC Scopus subject areas

  • Anatomy
  • Cell Biology
  • Histology

Cite this

Endoscopic ultrasound-guided fine needle aspiration of the pancreas : Diagnostic utility and accuracy. / Afify, Alaa M; Al-Khafaji, Basim M.; Kim, Byungki; Scheiman, James M.

In: Acta Cytologica, Vol. 47, No. 3, 2003, p. 341-348.

Research output: Contribution to journalArticle

Afify, Alaa M ; Al-Khafaji, Basim M. ; Kim, Byungki ; Scheiman, James M. / Endoscopic ultrasound-guided fine needle aspiration of the pancreas : Diagnostic utility and accuracy. In: Acta Cytologica. 2003 ; Vol. 47, No. 3. pp. 341-348.
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abstract = "OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is regarded as a safe and reliable procedure for diagnosing and staging of pancreatic neoplasms. This study retrospectively evaluated both the diagnostic utility and accuracy of pancreatic EUS-FNABs and potential cytologic pitfalls when using Diff-Quik{\circledR} stain for on-site evaluation. STUDY DESIGN: Pancreatic EUS-FNABs performed between 1995 and 1998 were identified from the files of the Department of Pathology. All patients were studied via a linear-array ultrasound endoscope with an FNAB device. Immediate evaluation of the specimen by a pathologist using air-dried slides and Diff-Quik{\circledR} stain was done on all cases. An average of five passes (range, three to nine) were performed. Five cytologic categories were identified: nondiagnostic, benign, atypical, suspicious and malignant. EUS disease staging, histologic correlation and clinical follow-up were reviewed. RESULTS: Sixty-nine consecutive pancreatic FNABs were evaluated in the study period. The patients comprised 38 females and 31 males with a mean age of 65 years (range, 36-83). Histologic correlation was available on 40 patients, and followup was available on the remaining 29. The cytologic diagnoses included: 31 malignant, 8 suspicious, 6 atypical, 20 benign and 4 nondiagnostic. Forty-three cases were true positive, 9 were true negative, 2 were false positive, and 11 were false negative. The overall sensitivity was 80{\%} and specificity was 82{\%}. CONCLUSION: The study showed that cytologic evaluation of pancreatic EUS-FNABs has 80{\%} sensitivity and 82{\%} specificity. False negative diagnosis was usually due to sampling error. A nondiagnostic cytologic diagnosis should be rendered in the absence of adequate sampling of a lesion. On-site cytologic evaluation of EUSFNABs aids in guaranteeing specimen adequacy, and the pathologist should be trained to evaluate Diff Quik{\circledR}-stained samples.",
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AB - OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is regarded as a safe and reliable procedure for diagnosing and staging of pancreatic neoplasms. This study retrospectively evaluated both the diagnostic utility and accuracy of pancreatic EUS-FNABs and potential cytologic pitfalls when using Diff-Quik® stain for on-site evaluation. STUDY DESIGN: Pancreatic EUS-FNABs performed between 1995 and 1998 were identified from the files of the Department of Pathology. All patients were studied via a linear-array ultrasound endoscope with an FNAB device. Immediate evaluation of the specimen by a pathologist using air-dried slides and Diff-Quik® stain was done on all cases. An average of five passes (range, three to nine) were performed. Five cytologic categories were identified: nondiagnostic, benign, atypical, suspicious and malignant. EUS disease staging, histologic correlation and clinical follow-up were reviewed. RESULTS: Sixty-nine consecutive pancreatic FNABs were evaluated in the study period. The patients comprised 38 females and 31 males with a mean age of 65 years (range, 36-83). Histologic correlation was available on 40 patients, and followup was available on the remaining 29. The cytologic diagnoses included: 31 malignant, 8 suspicious, 6 atypical, 20 benign and 4 nondiagnostic. Forty-three cases were true positive, 9 were true negative, 2 were false positive, and 11 were false negative. The overall sensitivity was 80% and specificity was 82%. CONCLUSION: The study showed that cytologic evaluation of pancreatic EUS-FNABs has 80% sensitivity and 82% specificity. False negative diagnosis was usually due to sampling error. A nondiagnostic cytologic diagnosis should be rendered in the absence of adequate sampling of a lesion. On-site cytologic evaluation of EUSFNABs aids in guaranteeing specimen adequacy, and the pathologist should be trained to evaluate Diff Quik®-stained samples.

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KW - Pancreatic cancer

KW - Pancreatic diseases

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