A Triple Approach for Diagnostic Assessment of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Pancreatic Solid Masses and Lymph Nodes

• Published in: Digestive diseases and sciences 2014-09, Vol.59 (9), p.2286-2293
• Main Authors: Lee, Yun Nah, Moon, Jong Ho, Kim, Hee Kyung, Choi, Hyun Jong, Lee, Seoung Ho, Choi, Moon Han, Kim, Dong Choon, Lee, Tae Hoon, Cha, Sang-Woo, Cho, Young Deok, Park, Sang-Heum
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Aged; Azure Stains; Biochemistry; Coloring Agents; Diagnosis; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endoscopy; Female; Gastroenterology; Hepatology; Humans; Immunohistochemistry; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Methylene Blue; Middle Aged; Neuroendocrine Tumors - pathology; Oncology; Original Article; Pancreatic cancer; Pancreatic Neoplasms - pathology; Pneumoviridae; Retrospective Studies; Sensitivity and Specificity; Staining and Labeling; Transplant Surgery; Xanthenes
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-014-3119-1

Background and Aims Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been becoming the standard tool for acquiring pancreatic lesion tissue. However, a single cytologic or histologic evaluation is not satisfactory for diagnosis. In this study, we evaluated the diagnostic yield of EUS–FNA for pancreatic solid masses and intra-abdominal lymph nodes using a triple approach. Methods This study included patients undergoing evaluation for a solid pancreatic mass ( n  = 59) or intra-abdominal lymph nodes ( n  = 16) using EUS–FNA with a 22- or 25-gauge (G) needle, respectively. The specimens from each pass were analyzed by on-site cytology using Diff-Quick stain, cytology using Papanicolaou stain, and histology with immunohistochemical (IHC) staining. Results A total of 75 patients (49 males; mean age; 63.7 years) were included. The median number of needle pass for diagnosis of malignancy was 2.0, and there was no technical failure. The diagnostic accuracies with on-site cytology, cytology using Papanicolaou staining, and histology were 70.7, 80.0, and 80.0 %, respectively. The diagnostic accuracy using a triple approach was significantly greater than cytology using Papanicolaou staining alone (94.7 vs. 80.0 %; p  = 0.007). In patients with malignant lesions, cytology identified 12 of 71 (16.9 %) malignant lesions that were not diagnosed by histology using IHC, and histology identified six (8.5 %) malignant lesions that were not diagnosed by cytology. Conclusion On-site cytopathologic evaluation combined with cytologic and histologic analysis with IHC stain for one-pass specimen is considered to be able to increase the overall accuracy of EUS–FNA in pancreatic solid masses and lymph nodes.