Impact of EUS-guided fine needle aspiration on the evaluation of pancreatic masses

EUS-guided fine needle aspiration of pancreatic masses has been safely performed for the evaluation of pancreatic masses. Its impact on patient management has not been fully elucidated. Methods: Patients with pancreatic masses identified on CT scan, who had no sign of metastatic disease, were studied via the linear array ultrasound endoscope (FG 32 UA, Pentax, Orangeburg, NY). The masses were aspirated using the GIF 22 gauge needle (Medi-Globe, Tempe, AZ). Passes were performed until the on-site cytopathologist identified malignant cells, or a total of five passes with adequate cells had been obtained. Surgical pathology or clinical follow-up were used to calculate the sensitivity, the specificity, and the accuracy of the technique. Patients were then followed-up to evaluate the safety of the technique and its impact on clinical management decisions. Results: A total of 23 patients with solid pancreatic masses identified by CT scan were referred for evaluation. There distribution was as follows: advanced cancer limited cancer benign mass total n= 17 4 2 23 EUS-FNA(+) 16 1 2 19 EUS-guided fine needle aspiration correctly identified 17/21 malignant masses (16 advanced and 1 limited), and 2/2 patients with benign masses (sensitivity = 81%, specificity = 100%, accuracy = 90%). Clinical impact was only apparent on the 16 patients with tissue confirmation of their advanced pancreatic cancer: 14 patients had no further work-up along with the initiation of chemo-radiotherapy, and two patients underwent the initiation of non-surgical palliative therapy. Clinical impact was not felt on any of the patient who had limited cancer or benign masses, whether tissue confirmation was obtained or not. All six patients went on to a whipple resection for their mass. There was one complication (minor bleeding) which required blood transfusion, but ceased spontaneously. Conclusions: EUS-guided fine needle aspiration is a sensitive technique that has strong impact on the clinical management of patients with advanced pancreatic cancer. Its use in the evaluation of patients with small pancreatic masses (malignant or benign) may need to be re-examined.