EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement.
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.
Savides
Thomas J
TJ
Division of Gastroenterology, University of California, Naval Medical Center, San Diego, CA 92093-0063, USA.
Donohue
Michael
M
Hunt
Gordon
G
Al-Haddad
Mohammed
M
Aslanian
Harry
H
Ben-Menachem
Tamir
T
Chen
Victor K
VK
Coyle
Walter
W
Deutsch
John
J
DeWitt
John
J
Dhawan
Manish
M
Eckardt
Alexander
A
Eloubeidi
Mohamad
M
Esker
Alec
A
Gordon
Stuart R
SR
Gress
Frank
F
Ikenberry
Steven
S
Joyce
Ann Marie
AM
Klapman
Jason
J
Lo
Simon
S
Maluf-Filho
Fauze
F
Nickl
Nicholas
N
Singh
Virmeet
V
Wills
Jason
J
Behling
Cynthia
C
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