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      Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors

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          Abstract

          Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to obtain a definitive diagnosis of pancreatic tumors. Good results have been reported for its diagnostic accuracy, with high sensitivity and specificity of around 90%; however, technological developments and adaptations to improve it still further are currently underway. The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of EUS-FNA are known. This review provides various techniques and equipment for improvement in the diagnostic accuracy in EUS-FNA.

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          Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses.

          Yousuke Nakai, Hiroyuki Isayama, Kenneth Chang … (2014)
          Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic masses is an established procedure for obtaining a pathological specimen. However, application of suction during EUS-FNA is still controversial and the efficacy of the slow-pull technique was recently reported for new core biopsy needles.
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            Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses.

            Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda … (2011)
            Since it was developed in 1992, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been widely used and has been adapted for gastrointestinal and perigastrointestinal lesions. A medical literature review to evaluate the role of EUS-FNA for diagnosis of solid pancreatic masses showed a 78-95% sensitivity, 75-100% specificity, 98-100% positive predictive value, 46-80% negative predictive value and a 78-95% accuracy. The reported complication rates of EUS-FNA for pancreatic solid masses were 0-2%, although the criteria for complications varied among the studies. Because of its high diagnostic yield and low complication rate, EUS-FNA is cost-effective and widely applicable for the diagnosis of solid pancreatic masses, and is the best initial and the preferred secondary method compared with other biopsy techniques, such as endoscopic retrograde cholangiopancreatography-guided biopsy, computed tomography/ultrasound-FNA and surgery. Although EUS-FNA is 'a nearly perfected procedure,' controversy remains, such as the most suitable diameter of the needle, the appropriate number of needle passes and the necessity of on-site cytopathological evaluation. Recently investigators reported that using molecular analysis of EUS-FNA samples can achieve a higher diagnostic efficacy. Further research is encouraged to optimize the EUS-FNA procedure to reach its maximum diagnostic yield for solid pancreatic masses. © 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.
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              Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy.

              W Brugge, Sevdenur Cizginer, Martha B. Pitman … (2009)
              EUS-guided FNA has the potential to provide diagnostic cytologic material from pancreatic lesions that are suspicious for malignancy. To determine the operating characteristics of EUS-FNA in the diagnosis of pancreatic adenocarcinoma and pancreatic neuroendocrine neoplasms (PENs). Retrospective analysis of a prospectively maintained database. Academic tertiary-care center. This study involved 559 patients undergoing evaluation of pancreatic masses or diffuse pancreatic parenchymal abnormalities. Performance characteristics of EUS-FNA of pancreatic adenocarcinoma and PEN. From January 1997 to December 2005, 737 patients undergoing initial EUS-FNA evaluation for a pancreatic mass were identified. In the final analysis, 559 patients with 560 FNA-sampled lesions were included. Overall, 442 lesions were pancreatic adenocarcinoma, and 40 were PEN. The sensitivity of EUS-FNA in the diagnosis of pancreatic adenocarcinomas and PENs was 77% (95% CI, 72.8%-80.8%) and 68% (95% CI, 50.8%-80.9%), respectively, using strict cytologic criteria. Reclassification of atypical and suspicious cytologies as diagnostic of malignancy resulted in a sensitivity of 93%, (95% CI, 90.9%-99.7%) in adenocarcinoma and 80% (95% CI, 63.9%-90.4%) in PEN. Tumor size, tumor location, and number of needle passes did not significantly influence diagnosis, but immediate cytologic evaluation was influential. Retrospective analysis at a single center. In a large, well-controlled study, EUS-FNA was found to be an accurate test (80%) for the detection of pancreatic adenocarcinoma by using aspiration cytology. The accuracy of the examination is significantly improved (94%) when atypical and suspicious samples are considered positive. Finally, only 2 to 3 FNA passes may be needed to achieve a good diagnostic yield. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endosc Ultrasound
                Journal ID (iso-abbrev): Endosc Ultrasound
                Journal ID (publisher-id): EUS
                Title: Endoscopic Ultrasound
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2303-9027
                ISSN (Electronic): 2226-7190
                Publication date (Print): Jul-Aug 2016
                Volume: 5
                Issue: 4
                Pages: 225-232
                Affiliations
                [1]Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
                [1 ]MD Anderson Cancer Center, University of Texas, Houston, TX, USA
                Author notes
                Address for correspondence Dr. Atsushi Irisawa, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan. E-mail: irisawa@ 123456fmu.ac.jp
                Article
                Publisher ID: EUS-5-225
                DOI: 10.4103/2303-9027.187862
                PMC ID: 4989402
                PubMed ID: 27503153
                SO-VID: f354bdb8-cb32-4c5a-a572-27f54899c809
                Copyright © Copyright: © 2016 Spring Media Publishing Co. Ltd
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 17 April 2016
                Date accepted : 09 June 2016
                Categories
                Subject: Review Article

                Keywords: diagnostic accuracy,endoscopic ultrasound-guided fine-needle aspiration,pancreatic tumors
                Data availability:
                Keywords: diagnostic accuracy, endoscopic ultrasound-guided fine-needle aspiration, pancreatic tumors

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