title: EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics.
abstract: BACKGROUND
  The clinical utility of EUS-FNA is debated in patients with obstructive jaundice (ObJ) because of a very high pretest probability of pancreatobiliary malignancy (PBM) and biliary stent-induced inflammation that can potentially confound EUS-FNA diagnosis. EUS-FNA also has lower accuracy in patients with underlying chronic pancreatitis (CP).
  
  
  OBJECTIVE
  Our purpose was to determine the clinical value of EUS-FNA for PBM diagnosis based on clinical presentation and presence of CP.
  
  
  METHODS
  Retrospective analysis of prospective database.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Patients who underwent EUS-FNA from 2002 to 2006 for suspected PBM based on (1) ObJ with biliary stricture or a mass lesion or (2) abnormal pancreatic imaging by CT/MRI: a focal pancreatic "mass" lesion; dilated pancreatic duct +/- common bile duct; or an enlarged head of pancreas.
  
  
  METHODS
  EUS was performed with a radial echoendoscope followed by a linear echoendoscope if a focal pancreatic lesion was identified. Fine-needle aspirates were assessed immediately by an attending cytopathologist.
  
  
  METHODS
  (1) Prevalence of cancer and (2) performance characteristics of EUS-FNA.
  
  
  RESULTS
  PBM was diagnosed in 73.9% of patients with ObJ and biliary stricture or pancreatic mass, in 49.6% of patients with pancreatic mass, and in 7.0% of patients with an enlarged head of pancreas or dilated pancreatic duct +/- common bile duct. The prevalence of PBM was lower in all 3 presentations with associated CP. Both CP and presentation with ObJ lowered performance characteristics of EUS-FNA, but CP did so only in the subset of patients with ObJ. All except 1 false-negative diagnoses were due to cytologic misinterpretation.
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  Among patients with suspected PBM, the accuracy of EUS-FNA is significantly lower only in a subset of patients with ObJ with underlying CP, largely as a result of difficulty in cytologic interpretation.
authors.affiliation: Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St Louis, Missouri 63110, USA.
authors.forename: Naveen B
authors.initials: NB
authors.lastname: Krishna
authors.forename: Mohit
authors.initials: M
authors.lastname: Mehra
authors.forename: Amith V
authors.initials: AV
authors.lastname: Reddy
authors.forename: Banke
authors.initials: B
authors.lastname: Agarwal
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000175:diagnosis; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology