title: An evaluation of risk factors for inadequate cytology in EUS-guided FNA of pancreatic tumors and lymph nodes.
abstract: BACKGROUND
  The factors associated with maximizing the cytological adequacy of EUS-guided FNA (EUS-FNA) in pancreatic tumor evaluation are not well-known.
  
  
  OBJECTIVE
  To examine associations of physician and procedural factors with the endpoint: the presence of an adequate cytological specimen found by using EUS-FNA in patients with pancreatic tumors and lymph nodes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A U.S. tertiary care center.
  
  
  METHODS
  Patients undergoing EUS-FNA of pancreatic masses and lymph nodes.
  
  
  METHODS
  Analysis of EUS-FNA procedures performed in our institution from 1997 to 2007.
  
  
  METHODS
  Associations were evaluated between the primary endpoint of cytological adequacy and factors including the endoscopist, needle gauge, the number of needle passes attempted, the pathologist, and the presence of an onsite cytotechnologist to confirm an adequate specimen. EUS-FNA adequacy was determined by a pathologist based on the presence of definite benign or malignant tissue.
  
  
  RESULTS
  EUS-FNA was performed in 247 pancreatic masses and 276 lymph nodes. An adequate cytological sample was obtained in 240 (97%) pancreatic tumors (95% CI, 94%-99%) and 252 (91%) lymph nodes (95% CI, 87%-94%). For pancreatic tumors, there was no evidence of any associations between factors and cytological adequacy. For lymph nodes, cytological adequacy was improved when an onsite cytotechnologist was present (96% vs 84%, P = .002); no other factors showed statistically significant associations with cytological adequacy.
  
  
  CONCLUSIONS
  Retrospective study, low power to detect associations.
  
  
  CONCLUSIONS
  The presence of an onsite cytotechnologist is an important factor in achieving successful EUS-FNA of suspicious lymph nodes in patients with pancreatic masses.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, Florida, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cleveland
authors.forename: Kanwar Rupinder S
authors.initials: KR
authors.lastname: Gill
authors.forename: Susan G
authors.initials: SG
authors.lastname: Coe
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Woodward
authors.forename: Massimo
authors.initials: M
authors.lastname: Raimondo
authors.forename: Laith
authors.initials: L
authors.lastname: Jamil
authors.forename: Seth A
authors.initials: SA
authors.lastname: Gross
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Julia E
authors.initials: JE
authors.lastname: Crook
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D003584:Cytological Techniques / Q000592:standards*; D003951:Diagnostic Errors; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors