title: Repeated endoscopic ultrasound guided fine needle aspiration (EUS-FNA) improved diagnostic yield of inconclusive initial cytology for suspected pancreatic cancer and unknown intra-abdominal lymphadenopathy.
abstract: BACKGROUND
  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is considered as an effective technique to obtain cytology specimens for definite diagnosis of the patients who were suspected of having pancreatic cancer and unknown intra-abdominal lymphadenopathy. The value of repeated EUS-FNA in these patients who had inconclusive first EUS-FNA cytology is not well established.
  
  
  OBJECTIVE
  To determine the yield of repeated EUS-FNA in obtaining a definite diagnosis in patients with clinically suspect for pancreatic cancer and unknown intra-abdominal lymphadenopathy including the reasons for which initial EUS-FNA failed.
  
  
  METHODS
  The authors retrospectively reviewed the EUS database of Siriraj endoscopy center from January 2007 to May 2011, to identify all patients who underwent repeated EUS-FNA for high index suspicion of pancreatic cancer and unknown intra-abdominal lymphadenopathy. The inconclusive results of the first EUS-FNA, the factors associated with non-diagnosed versus diagnosed cytology results were compared.
  
  
  RESULTS
  A total of 478 EUS- FNA were performed in our institution. Fifteen patients (6M, 9F), mean age of 57 +/- 11.8 years (30-72 years) had repeated EUS-FNA done for the evaluation of possible malignant diseases. Eight of these patients presented with pancreatic masses and the other seven patients had unknown intra-abdominal lymphadenopathy. The second EUS-FNA diagnosed and was truly benign in 4 patients. Repeated EUS-FNA facilitated determination of the true status of the disease in 13 of 15 patients which 9 of whom were malignancy. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of repeated EUS-FNA for both inconclusive pancreatic masses and unknown intra-abdominal lymphadenopathy were 90%, 100%, 100%, 80% and 92.8% respectively.
  
  
  CONCLUSIONS
  Repeated EUS-FNA for inconclusive initial cytology of patients with suspected pancreatic cancer and unknown intra-abdominal lymphadenopathy provided a very high yield for definite tissue diagnosis and should be recommended.
authors.affiliation: Siriraj GI Endoscopy Center, Department of Internal Medicine, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand. kaiyjr@gmail.com
authors.forename: Varayu
authors.initials: V
authors.lastname: Prachayakul
authors.forename: Tassanee
authors.initials: T
authors.lastname: Sriprayoon
authors.forename: Pitulak
authors.initials: P
authors.lastname: Asawakul
authors.forename: Supot
authors.initials: S
authors.lastname: Pongprasobchai
authors.forename: Nonthalee
authors.initials: N
authors.lastname: Pausawasdi
authors.forename: Udom
authors.initials: U
authors.lastname: Kachintorn
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity