title: EUS-guided FNA of solid pancreatic masses: high yield of 2 passes with combined histologic-cytologic analysis.
abstract: BACKGROUND
  EUS-guided FNA (EUS-FNA) is an established tissue-acquisition technique, with most studies concentrating on cytologic analyses of specimens, with only few data existing on histologic assessment.
  
  
  OBJECTIVE
  To assess the sensitivity of a combined analysis of histologic followed by cytologic tissue diagnosis.
  
  
  METHODS
  A retrospective 3-center study.
  
  
  METHODS
  In consecutive patients undergoing FNA of solid pancreatic masses, core specimens were harvested for histology; residual tissue was examined cytologically. Only unequivocally positive results were regarded as malignant. Criterion standards were positive results from EUS-FNA or other histologic findings, or, if negative, clinical follow-up data (minimum 12 months).
  
  
  RESULTS
  Among 192 patients (110 men; mean age 63 years) with mostly pancreatic-head masses (72.4%), overall, adequate tissue was obtained in 98.9% of all cases, with a mean of 1.88 needle passes and an overall sensitivity of 82.9% (95% CI, 76.0%-88.5%). Histology and subsequent cytology provided adequate tissue and sensitivities of 86.5% and 60%, and 92.7% and 68.1%, respectively. Excluding cases with inadequate specimens, sensitivities rose by 4% to 10%. Histology showed a trend for superiority over cytology only in characterizing nonadenocarcinoma tumor types. No differences in sensitivity were found between the centers involved.
  
  
  CONCLUSIONS
  Retrospective design, different processing of cytologic specimens.
  
  
  CONCLUSIONS
  At EUS-FNA in pancreatic masses, combined histologic-cytologic analysis achieved a sensitivity of more than 80%, despite a low number of needle passes and may thus save time. Histology alone did not reach higher sensitivity than cytology. In particular situations, eg, rare tumors, histology may still be required.
authors.affiliation: Department of Internal Medicine I, Oskar-Ziethen Hospital Lichtenberg, Berlin, Germany.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Möller
authors.forename: Ioannis S
authors.initials: IS
authors.lastname: Papanikolaou
authors.forename: Thomas
authors.initials: T
authors.lastname: Toermer
authors.forename: Eumorphia M
authors.initials: EM
authors.lastname: Delicha
authors.forename: Mario
authors.initials: M
authors.lastname: Sarbia
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schenck
authors.forename: Martin
authors.initials: M
authors.lastname: Koch
authors.forename: Hussain
authors.initials: H
authors.lastname: Al-Abadi
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schulz
authors.forename: Bertram
authors.initials: B
authors.lastname: Wiedenmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D003584:Cytological Techniques; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity