title: Endoscopic ultrasound-guided fine needle aspiration biopsy of pancreatic lesions. An 8-year analysis of single institution material focusing on efficacy and learning progress.
abstract: OBJECTIVE
  To evaluate the efficacy and the learning curve of the endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) diagnostics of pancreatic lesions over 8 years (2007-2014).
  
  
  METHODS
  EUS-FNAB using a Linear Echoendoscope Olympus was performed in 531 patients, mostly without rapid on-site evaluation (ROSE). Smears plus cytoblock sections were used routinely. Immunocytochemistry was utilised as indicated.
  
  
  RESULTS
  The average, satisfactory sampling rate increased from the 61.2% in the first 3-year period to 72.9% in the last 3-year period (P = 0.008). The availability of the material for cytoblocks increased from 36.4% in the first period to 75.3% in the last period (P = 0.017). The efficacy of cytoblocks increased from 39.6% to 46.2% (P = 0.086). Comparing the first and last 3-year periods, the indication for immunocytochemistry did not rise substantially (5.2% and 8.5% respectively), but the predictive value of immunocytochemistry rose from 56.3% to 100.0% (P = 0.001). The most frequent diagnostic result was malignancy confirmation - both primary (41.2%) and metastatic (2.1%). In cases with representative samples and follow-up information, the specificity, sensitivity, positive predictive value and accuracy were high from the beginning. The negative predictive value decreased slightly in the last 3-year period.
  
  
  CONCLUSIONS
  The pancreatic EUS-FNAB without ROSE represents a suboptimal arrangement conditioned with our staff/time/location reality. Nevertheless, within the last 3 years of our activity, nearly three-quarters of patients profit from the diagnostic contribution of this procedure.
authors.affiliation: 1st Faculty of Medicine, Institute of Pathology, Charles University, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Dušková
authors.affiliation: 4th Department of Medicine, Faculty General Hospital, Charles University, Prague, Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Krechler
authors.affiliation: 4th Department of Medicine, Faculty General Hospital, Charles University, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Dvořák
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: endoscopic ultrasound guided aspiration biopsy; fine needle aspiration; learning curve; pancreatic neoplasms; sampling efficacy