title: Neoplasia in chronic pancreatitis: how to maximize the yield of endoscopic ultrasound-guided fine needle aspiration.
abstract: When performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), identifying neoplasia in the setting of chronic pancreatitis can be technically challenging. The morphology of an ill-defined mass on sonography, presence of calcifications or intervening collaterals, reverberation from a biliary stent, low yield of tissue procurement, and interpretative errors in cytopathology can result in both false-negative and false-positive results. Although these challenges cannot be completely eliminated, elastography or contrast-enhanced imaging can aid in differentiating an inflammatory mass from a neoplasm. Also, performing more passes of FNA, procuring core biopsy material, performing rapid onsite evaluation, conducting ancillary pathology studies, and even repeating the procedure on a different day can aid in improving the diagnostic performance of EUS-FNA. This review provides a concise update and offers practical tips to improving the diagnostic yield of EUS-FNA when sampling solid pancreatic mass lesions in the setting of chronic pancreatitis.
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, FL, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, FL, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
keywords: Biopsy; Biopsy, fine-needle; Endosonography; Pancreatic neoplasms; Pancreatitis, chronic