title: Lower yield of endoscopic ultrasound-guided fine-needle aspiration in patients with pancreatic head mass with a biliary stent.
abstract: BACKGROUND
  In jaundiced patients with suspected pancreatic cancer, endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent is frequently performed prior to histologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).
  
  
  OBJECTIVE
  To compare the accuracy of jaundiced patients undergoing EUS-FNA for a pancreatic mass with or without a biliary stent.
  
  
  METHODS
  Consecutive patients with a pancreatic mass and jaundice who underwent EUS-FNA between 4/2005 and 4/2013 were identified. Final diagnosis was based on histologic or radiologic evaluation with >6-month follow-up if the index EUS-FNA was negative for malignancy. Primary endpoint was histologic accuracy of EUS-FNA.
  
  
  RESULTS
  Mean age of the 180 patients was 65 ± 12 years; 83 (46 %) had ERCP prior to EUS-FNA and 75 (42 %) received a biliary stent. Onsite cytopathologist was present for 81 (45 %) procedures. Final diagnosis revealed malignancy in 172 (96 %) patients, with adenocarcinoma in 159 (88 %). Patients with biliary stents had lower accuracy of EUS-FNA for malignancy than those without a biliary stent: 77 % (95 % CI 67-85 %) versus 89 % (95 % CI 81-93 %). On multivariate analysis, having a biliary stent (OR = 0.37, 95 % CI 0.15-0.90), onsite cytopathologist (OR = 9.24, 95 % CI 2.64-32.37), and receiving a core biopsy (OR = 2.60, 95 % CI 1.07-6.29) were associated with accuracy of EUS-FNA.
  
  
  CONCLUSIONS
  Presence of a biliary stent was associated with a significant decrease in the accuracy of EUS-FNA for histologic diagnosis of pancreatic cancer, while accuracy was increased when a cytopathologist was onsite. EUS-FNA should be performed prior to ERCP in jaundiced patients with suspected pancreatic cancer.
authors.affiliation: Division of Gastroenterology, Loma Linda University Medical Center, 11234 Anderson Street, Room 1556, Loma Linda, CA, 92354, USA, jojkim@llu.edu.
authors.forename: John J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Sukhpreet
authors.initials: S
authors.lastname: Walia
authors.forename: Scott H
authors.initials: SH
authors.lastname: Lee
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Patel
authors.forename: Madhavi
authors.initials: M
authors.lastname: Vetsa
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Wichit
authors.initials: W
authors.lastname: Srikureja
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome