title: Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis.
abstract: OBJECTIVE
  The clinical value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic lesions is uncertain in patients with normal parenchyma and chronic pancreatitis. The aim of this study was to analyze the diagnostic yield and influence of EUS-FNA on the clinical management of patients with pancreatic lesions, in the presence (CP) or absence (NP) of chronic pancreatitis.
  
  
  METHODS
  A total of 207 consecutive patients with NP (n = 133) and CP (n = 74) were examined using linear array echo endoscopes for the procedure and 22-gauge needles.
  
  
  RESULTS
  Adequate specimens were obtained from 200 lesions. A correct final diagnosis was established at histology (n = 108), bacteriology (n = 9), and clinical follow-up (n = 83). Cytology gave 17 false-negative EUS-FNA results (overall sensitivity: 85%). In patients with NP, 60 solid adenocarcinomas were detected, 32 other malignancies, and 38 benign lesions, with 11 false-negative results (sensitivity: 89%). In patients with CP, only seven of 13 malignancies (all solid adenocarcinomas) were identified using FNA (sensitivity: 54%). Overall, malignancy was identified in 116 patients, 32 of whom (27%) had lesions other than primary solid adenocarcinomas. Management was altered in 25 of these patients, which changed the surgical approach in 21%. EUS-FNA influenced the therapeutic approach in 44% of the total patient group.
  
  
  CONCLUSIONS
  EUS-FNA was especially useful in patients with a focal pancreatic lesion with normal parenchyma. Its sensitivity in patients with CP was unacceptably low, and resection of the tumor using standard surgical techniques was still usually required to confirm the correct diagnosis. Diagnostic EUS-FNA influenced clinical management in nearly half of patients.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital, Eppendorf, Hamburg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Fritscher-Ravens
authors.forename: Lars
authors.initials: L
authors.lastname: Brand
authors.forename: W Trudo
authors.initials: WT
authors.lastname: Knöfel
authors.forename: Christoph
authors.initials: C
authors.lastname: Bobrowski
authors.forename: Theodoros
authors.initials: T
authors.lastname: Topalidis
authors.forename: Frank
authors.initials: F
authors.lastname: Thonke
authors.forename: Andreas
authors.initials: A
authors.lastname: de Werth
authors.forename: Nib
authors.initials: N
authors.lastname: Soehendra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000379:methods; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010195:Pancreatitis / Q000150:complications*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity