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Savides, Thomas J., MD; Donohue, Michael, PhD; Hunt, Gordon, MD; Al-Haddad, Mohammed, MD; Aslanian, Harry, MD; Ben-Menachem, Tamir, MD; Chen, Victor K., MD MSPH; Walter Coyle, MD; Deutsch, John, MD; DeWitt, John, MD; Dhawan, Manish, MD; Eckardt, Alexander, MD; Eloubeidi, Mohamad, MD; Esker, Alec, MD; Gordon, Stuart R., MD; Gress, Frank, MD; Ikenberry, Steven, MD; Joyce, Ann Marie, MD; Klapman, Jason, MD; Lo, Simon, MD; Maluf-Filho, Fauze, MD; Nickl, Nicholas, MD; Singh, Virmeet, MD; Wills, Jason, MD; Behling, Cynthia, MD, PhD
Gastrointestinal endoscopy, 08/2007, Letnik: 66, Številka: 2Journal Article
Background The diagnostic yield of EUS-guided FNA (EUS-FNA) of solid pancreatic masses is a potential benchmark for EUS-FNA quality, because the majority of EUS-FNA of solid pancreatic masses should be diagnostic for malignancy. Objectives To determine the cytologic diagnostic rate of malignancy in EUS-FNA of solid pancreatic masses and to determine if variability exists among endoscopists and centers. Design Multicenter retrospective study. Patients EUS centers provided cytology reports for all EUS-FNAs of solid, noncystic, ≥10-mm-diameter, solid pancreatic masses during a 1-year period. Main Outcome Measurement Cytology diagnostic of pancreatic malignancy. Results A total of 1075 patients underwent EUS-FNA at 21 centers (81% academic) with 41 endoscopists. The median number of EUS-FNA of solid pancreatic masses performed during the year per center was 46 (range, 4-177) and per endoscopist was 19 (range, 1-97). The mean mass dimensions were 32 × 27 mm, with 73% located in the head. The mean number of passes was 3.5. Of the centers, 90% used immediate cytologic evaluation. The overall diagnostic rate of malignancy was 71%, 95% confidence interval 0.69%-0.74%, with 5% suspicious for malignancy, 6% atypical cells, and 18% negative for malignancy. The median diagnostic rate per center was 78% (range, 39%-93%; 1st quartile, 61%) and per endoscopist was 75% (range, 0%-100%; 1st quartile, 52%). Limitations Retrospective study, participation bias, and varying chronic pancreatitis prevalence. Conclusions (1) EUS-FNA cytology was diagnostic of malignancy in 71% of solid pancreatic masses and (2) endoscopists with a final cytologic diagnosis rate of malignancy for EUS-FNA of solid masses that was less than 52% were in the lowest quartile and should evaluate reasons for their low yield.
