title: Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies.
abstract: BACKGROUND
  The factors that affect the number of needle passes needed to diagnose pancreatic malignancies using endoscopic ultrasound (EUS) -guided fine-needle aspiration are unknown.
  
  
  METHODS
  Patient and endosonographic data were prospectively recorded on 121 consecutive patients with pancreatic malignancy. Of these, 110 underwent EUS-guided fine-needle aspiration. A cytopathologist was in attendance for all aspiration procedures.
  
  
  RESULTS
  Initial EUS detected a pancreatic mass in 96% of cases; 23% of these were not seen by computed tomography. EUS-guided fine-needle aspiration was performed in 109 of 110 (99%) patients, including 95 masses, 7 lymph nodes, and 7 hepatic metastases. EUS-guided fine-needle aspiration provided a cytologic diagnosis of malignancy in 104 of 110 (95%). Only tumor differentiation and the site of aspiration affected the number of passes.
  
  
  CONCLUSIONS
  With the participation of a cytopathologist, EUS-guided fine-needle aspiration can diagnose pancreatic malignancies with a high degree of accuracy. Only the aspiration site (mass versus node/liver metastasis) can be used to direct the number of passes if a cytopathologist is not present. Without a cytopathologist in attendance, 5 to 6 passes should be made for pancreatic masses and 2 to 3 for liver metastases or lymph nodes; however, this approach will be associated with a 10% to 15% reduction in definitive cytologic diagnoses, extra procedure time, increased risk and additional needles.
authors.affiliation: Departments of Medicine and Pathology, Scott & White, Texas A&M Health Science Center, Temple, TX 76508, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Erickson
authors.forename: L
authors.initials: L
authors.lastname: Sayage-Rabie
authors.forename: R S
authors.initials: RS
authors.lastname: Beissner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D003581:Cytodiagnosis; D019160:Endosonography; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D018084:Ultrasonography, Interventional