title: EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Multicenter retrospective study.
  
  
  METHODS
  EUS centers provided cytology reports for all EUS-FNAs of solid, noncystic, >or=10-mm-diameter, solid pancreatic masses during a 1-year period.
  
  
  METHODS
  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 x 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, University of California, Naval Medical Center, San Diego, CA 92093-0063, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
authors.forename: Michael
authors.initials: M
authors.lastname: Donohue
authors.forename: Gordon
authors.initials: G
authors.lastname: Hunt
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Haddad
authors.forename: Harry
authors.initials: H
authors.lastname: Aslanian
authors.forename: Tamir
authors.initials: T
authors.lastname: Ben-Menachem
authors.forename: Victor K
authors.initials: VK
authors.lastname: Chen
authors.forename: Walter
authors.initials: W
authors.lastname: Coyle
authors.forename: John
authors.initials: J
authors.lastname: Deutsch
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
authors.forename: Manish
authors.initials: M
authors.lastname: Dhawan
authors.forename: Alexander
authors.initials: A
authors.lastname: Eckardt
authors.forename: Mohamad
authors.initials: M
authors.lastname: Eloubeidi
authors.forename: Alec
authors.initials: A
authors.lastname: Esker
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: Frank
authors.initials: F
authors.lastname: Gress
authors.forename: Steven
authors.initials: S
authors.lastname: Ikenberry
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Joyce
authors.forename: Jason
authors.initials: J
authors.lastname: Klapman
authors.forename: Simon
authors.initials: S
authors.lastname: Lo
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf-Filho
authors.forename: Nicholas
authors.initials: N
authors.lastname: Nickl
authors.forename: Virmeet
authors.initials: V
authors.lastname: Singh
authors.forename: Jason
authors.initials: J
authors.lastname: Wills
authors.forename: Cynthia
authors.initials: C
authors.lastname: Behling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional