Value of endoscopic ultrasonography-guided fine needle aspiration (FNA) in the diagnosis of neoplastic tumor(-like) pancreatic lesions in daily clinical practice.
OBJECTIVE
To investigate the value of EUS-guided FNA in the diagnosis of solid and cystic pancreatic tumor(-like) lesions as well as metastatic tumor growth within peripancreatic lymph nodes and its impact on therapeutic decision-making. The results of the cytologic and pathohistological investigation were compared with i) each other and ii) the detection rates of various imaging procedures.


METHODS
Overall, 153 patients (mean age, 56.9 years) underwent EUS-guided FNA from I/ 2000 - III/ 2003.


RESULTS
Comparing various imaging procedures such as CT scan (80 %), MRI (57.1 %) and abdominal US (88.8 %), EUS achieved the highest diagnostic accuracy: 100 %. For EUS-based T-staging in 26 patients with malignant tumor lesions undergoing surgical intervention, there was a sensitivity of 73.3 % (specificity, 85.9 %; PPV, 69.2 %; NPV, 84.4 %), while the parameters for N-staging (n = 25) were: sensitivity, 61.5 %; specificity, 75 %; NPV, 64.3 %; PPV, 72.7 %. While the sensitivity of EUS-guided FNA in the group of patients who underwent surgical intervention (n = 55) was 81.4 % (specificity, 75 %; PPV, 92.1 %; NPV, 52.9 %), the parameters were as follows in the subgroup of individuals with chronic pancreatitis (n = 30): sensitivity in detecting a malignant pancreatic tumor lesion, 50 %; specificity, 91.7 %; PPV, 60 %; NPV, 88 %. Based on preoperative characteristics such as suspected diagnosis, TNM stage and tumor entity, a surgical intervention could be avoided in 29 / 153 patients (19 %).


CONCLUSIONS
EUS-guided FNA allows more precise diagnosis clarification (malignant tumor growth and tumor entity) in solid and cystic pancreatic tumor(-like) lesions, which may assist in early and sufficient therapeutic decision-making.
Will
U
U
Department of Gastroenterology, Municipal Hospital.
Mueller
A
A
Topalidis
T
T
Meyer
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D055815:Young Adult