title: A triple approach for diagnostic assessment of endoscopic ultrasound-guided fine needle aspiration in pancreatic solid masses and lymph nodes.
abstract: OBJECTIVE
  Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been becoming the standard tool for acquiring pancreatic lesion tissue. However, a single cytologic or histologic evaluation is not satisfactory for diagnosis. In this study, we evaluated the diagnostic yield of EUS-FNA for pancreatic solid masses and intra-abdominal lymph nodes using a triple approach.
  
  
  METHODS
  This study included patients undergoing evaluation for a solid pancreatic mass (n = 59) or intra-abdominal lymph nodes (n = 16) using EUS-FNA with a 22- or 25-gauge (G) needle, respectively. The specimens from each pass were analyzed by on-site cytology using Diff-Quick stain, cytology using Papanicolaou stain, and histology with immunohistochemical (IHC) staining.
  
  
  RESULTS
  A total of 75 patients (49 males; mean age; 63.7 years) were included. The median number of needle pass for diagnosis of malignancy was 2.0, and there was no technical failure. The diagnostic accuracies with on-site cytology, cytology using Papanicolaou staining, and histology were 70.7, 80.0, and 80.0 %, respectively. The diagnostic accuracy using a triple approach was significantly greater than cytology using Papanicolaou staining alone (94.7 vs. 80.0 %; p = 0.007). In patients with malignant lesions, cytology identified 12 of 71 (16.9 %) malignant lesions that were not diagnosed by histology using IHC, and histology identified six (8.5 %) malignant lesions that were not diagnosed by cytology.
  
  
  CONCLUSIONS
  On-site cytopathologic evaluation combined with cytologic and histologic analysis with IHC stain for one-pass specimen is considered to be able to increase the overall accuracy of EUS-FNA in pancreatic solid masses and lymph nodes.
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Yun Nah
authors.initials: YN
authors.lastname: Lee
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Kim
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Seoung Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Moon Han
authors.initials: MH
authors.lastname: Choi
authors.forename: Dong Choon
authors.initials: DC
authors.lastname: Kim
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Cha
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001399:Azure Stains; D004396:Coloring Agents; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013194:Staining and Labeling; D014966:Xanthenes
chemical_list: D001399:Azure Stains; D004396:Coloring Agents; C067461:Diff Quik; D014966:Xanthenes; D008751:Methylene Blue
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