Suspicious cytologic diagnostic category in endoscopic ultrasound-guided FNA of the pancreas: Follow-up and outcomes.
BACKGROUND
The objective of the current study was to assess how the suspicious category is followed up in a large endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) service, its outcomes, and the predictors that are likely to be associated with the subsequent diagnosis of a neoplastic process.


METHODS
For pancreatic EUS-FNA samples with the suspicious category diagnosis, the authors reviewed the electronic medical record for the method of follow-up and the risks associated with pancreatic malignancy. Logistic regression analysis was used to determine the risk factors that were likely to be associated with the diagnosis of a neoplastic lesion after a cytologic diagnosis of "suspicious."


RESULTS
Of a total of 3832 EUS-FNA cases, 116 were diagnosed with suspicious cytology. A total of 90 of 98 neoplasms (92%) were identified, including 72 carcinomas (73%). Similar rates of neoplasia were detected after repeat FNA (34 of 37 neoplasms [92%]) and subsequent biopsy/surgical resection (44 of 46 neoplasms [96%]), but significantly fewer neoplasms were detected among patients with clinical follow-up (18 of 23 neoplasms [78%]). On multivariate analysis of the potential predictive variables listed above, the presence of a mass was found to be significantly associated with a higher rate of diagnosis of a neoplasm, whereas weight loss was significantly associated with a diagnosis of carcinoma.


CONCLUSIONS
The diagnostic category of "suspicious" is associated with a high risk of benign and malignant neoplasms, regardless of the method of follow-up. The presence of a mass and weight loss are significant predictors of a subsequent diagnosis of a neoplasm after suspicious cytology. In patients with suspicious cytology and these findings, surgery is recommended for resectable masses and repeat FNA for unresectable masses.
Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Evan A
EA
Alston
Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Sejong
S
Bae
Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Isam A
IA
Eltoum
D000328:Adult; D000367:Age Factors; D000368:Aged; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors
diagnostic accuracy; endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA); guidelines; pancreas; suspicious