title: Implication of suspicious cytology in endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become a preferred technique to evaluate pancreatic masses. The clinical management of a "suspicious for adenocarcinoma" cytological diagnosis is unclear in unresectable cases. We sought to determine whether a suspicious diagnosis in the setting of a high clinical suspicion of malignancy could be sufficient for initiating non-operative therapy, such as chemotherapy, in unresectable patients.
  
  
  METHODS
  Twenty-nine solid pancreatic mass cytology specimens obtained by EUS-FNA with a diagnosis of suspicious for adenocarcinoma were identified from 2000 to 2012. Pathology, clinical, and radiologic data were analyzed.
  
  
  RESULTS
  Additional procedures were performed in 21 of the 29 patients. Sixteen of the 21 patients had confirmation of malignancy on further tissue sampling and an additional 2 had confirmed unresectable cancers during surgical exploration. Three of the 21 patients had benign diagnoses on subsequent tissue sampling. Of the remaining eight patients who did not undergo additional diagnostic procedures, six were deemed clinically malignant and treated, one died within a year of the EUS-FNA, and one was lost to follow-up.
  
  
  CONCLUSIONS
  Consideration of a suspicious diagnosis on EUS-FNA of solid pancreatic masses as sufficient for initiating non-operative therapy is reasonable in the setting of a high clinical suspicion of malignancy.
authors.affiliation: Departments of Pathology, University of Michigan Health System, 1500 E. Medical Center Dr, 2G340, Ann Arbor, MI, 48109-5054, USA.
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Shi
authors.forename: Madelyn
authors.initials: M
authors.lastname: Lew
authors.forename: Mark M
authors.initials: MM
authors.lastname: Zalupski
authors.forename: Michael H
authors.initials: MH
authors.lastname: Roh
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.forename: Judy C
authors.initials: JC
authors.lastname: Pang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003581:Cytodiagnosis / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*