Journal of Clinical Oncology, Vol 15, 1439-1443, Copyright © 1997 by American Society of Clinical Oncology
Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions
DO Faigel, GG Ginsberg, JS Bentz, PK Gupta, DB Smith and ML Kochman
Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA.
BACKGROUND: Endoscopic ultrasound (EUS) is an important new tool in the
staging of pancreatic malignancies. Using new curved linear-array
instruments, real-time fine-needle aspiration biopsy (RTFNA) of pancreatic
lesions can be performed. METHODS: Forty-five patients with pancreatic
lesions (22 males and 23 females) underwent staging with the Olympus EUM-20
(Olympus America Corp, Melville, NY) followed by EUS- RTFNA with the Pentax
FG-32PUA (Pentax-Precision Instrument Corp, Orangeburg, NY) and the
22-gauge GIP needle (GIP Medizin Technik, Grassau, Germany). RESULTS: EUS
tumor stages were as follows: TO, n = 1; T1, n = 8; T2, n = 9; and T3 n =
27. Aspiration attempts were unsuccessful in four patients (two technical
failures and two inadequate specimens). The remaining 41 lesions (mean
size, 3.3 cm) were aspirated under EUS guidance (median passes, three) and
the cytologic diagnoses were 25 definite adenocarcinoma, five suspicious
for adenocarcinoma (three subsequently confirmed and two clinical course
consistent with adenocarcinoma), and 11 negative for malignancy. Of 11
negatives, two were found to have adenocarcinoma, seven were confirmed
benign at surgery (four cystadenomas and three inflammatory), one had a
benign pseudocyst, and one had abundant inflammatory cells on RTFNA and
follow-up time greater than 12 months with computed tomographic (CT) scans
consistent with resolving inflammation. There were no false-positive
RTFNAs. There were no procedure-related complications. Among those with
diagnostic EUS-RTFNA (91%), the sensitivity for malignancy (confirmed plus
suspicious) was 94% and negative predictive value 82%. CONCLUSION:
EUS-guided RTFNA is a safe and accurate method for performing pancreatic
biopsy. It should be considered in patients with suspected pancreatic
malignancies in whom a tissue diagnosis is required or when other
modalities have failed. EUS- RTFNA allows for local staging and tissue
diagnosis in one procedure.
