title: Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care.
abstract: Background. There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions. To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required. The utility of repeat EUS-FNA is not well established. Methods. A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology. The wait times to the second procedure and to decisions regarding therapy were calculated. Results. Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions. Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%). Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA. The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%). The median time interval between first and second EUS-FNA was 31 (7-175) days. Conclusions. A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care.
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Robert A
authors.identifier: 0000-0001-8587-234X
authors.initials: RA
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Dylan
authors.initials: D
authors.lastname: Stanger
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Constantin
authors.initials: C
authors.lastname: Shuster
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Telford
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Lam
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Robert
authors.identifier: 0000-0002-9018-4522
authors.initials: R
authors.lastname: Enns
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D000368:Aged; D001955:British Columbia; D000066491:Clinical Decision-Making / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*