Predictive value of intra-abdominal lymph nodes in pancreatic endoscopic ultrasonography–guided fine-needle aspiration biopsy

• Published in: Journal of the American Society of Cytopathology JASC 2014-07, Vol.3 (4), p.206-210
• Main Authors: Collins, Brian T., MD, Bernadt, Cory T., MD, PhD, Adhikari, Laura J., MD, Wang, Jeff F., MD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Endoscopic ultrasonography; Fine-needle aspiration; Lymph node; Pancreas; Pathology
• ISSN: 2213-2945; 2213-2945
• DOI: 10.1016/j.jasc.2014.03.011

Introduction Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) biopsy is a commonly used method for the evaluation of pancreatic lesions. EUS-guided FNA of the intra-abdominal lymph nodes (LNs) can provide critical diagnostic information that is important for clinical management and tumor staging. This study examines the predictive value of intra-abdominal LN EUS-guided FNA biopsy associated with pancreatic lesions. Materials and methods Over a 10-year period, the pathology database was searched for patients with concurrent pancreas and intra-abdominal LN EUS-guided FNA biopsy. The corresponding reports were reviewed, and clinical information and diagnostic results were recorded. Results There were 252 cases where both a pancreas lesion and intra-abdominal LN were biopsied. Of this group, 182 LNs were classified as negative (72%), 47 as positive (19%), and 23 as atypical (9%). Within the negative LN cohort, the pancreas FNAs fell into the following diagnostic categories: benign (47%), malignant (30%), and atypical/suspicious (23%). Within the positive LN cohort, the pancreas lesion correlated with the following diagnostic categories: malignant (89%), atypical (4%), and suspicious (6%). A positive LN EUS-guided FNA biopsy had a 98% positive predictive value for malignancy. Within the atypical LN cohort, the pancreas correlated with the following diagnostic categories: malignant (57%), atypical/suspicious (26%), and benign (17%). Conclusions An atypical LN diagnostic category is strongly associated with a malignant pancreas lesion. A positive LN EUS-guided FNA biopsy has a 98% positive predictive value for pancreatic malignancy. A positive diagnostic category for an intra-abdominal LN can provide strong predictive evidence of a corresponding malignancy of the pancreas.