A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions

• Published in: Gastrointestinal endoscopy 2006-06, Vol.63 (7), p.966-975
• Main Authors: Horwhat, John David, Paulson, Erik K., McGrath, Kevin, Stanley Branch, M., Baillie, John, Tyler, Douglas, Pappas, Theodore, Enns, Robert, Robuck, Gail, Stiffler, Helen, Jowell, Paul
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Aged; Algorithms; Biological and medical sciences; Biopsy, Fine-Needle - methods; Cross-Over Studies; Digestive system. Abdomen; Endoscopy; Endoscopy, Gastrointestinal - methods; Endosonography; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.09.028

Diagnosing pancreatic cancer by EUS-FNA is a potentially appealing alternative to percutaneous biopsy. To compare EUS-FNA with CT or US-guided FNA for diagnosing pancreatic cancer. Single center, prospective, randomized, cross-over. Duke University Medical Center. Eighty-four patients referred with suspicious solid pancreatic mass lesions randomized to CT/US-FNA (n = 43) or EUS-FNA (n = 41). Patients underwent an imaging procedure/FNA. If cytology was nondiagnostic, cross over to the other modality was offered. Final outcome was determined by clinical follow-up every 6 months for 2 years and/or surgical pathology for patients with negative FNA. Sensitivity and accuracy of EUS-FNA versus CT/US-FNA for pancreatic cancer. There were 16 true positive (TP) by CT/US-FNA and 21 TP by EUS-FNA. Sixteen of the 20 CT/US-FNA negative patients crossed over to EUS-FNA; 12 underwent FNA, 4 had no mass at EUS. Seven of the 12 had positive EUS-FNA. Eight EUS-FNA negative crossed over to CT/US; 4 had no mass at CT/US, 3 remained true negative throughout follow-up, 1 had chronic pancreatitis at surgery. The sensitivity of CT/US-FNA and EUS-FNA for detecting malignancy was 62% and 84%, respectively. A comparison of the accuracy for CT/US-FNA and EUS-FNA was not statistically significant (P = .074, χ 2). Failure to meet target enrollment resulted in an inability to demonstrate a statistically significant difference between the 2 modalities. EUS-FNA is numerically (though not quite statistically) superior to CT/US-FNA for the diagnosis of pancreatic malignancy.