EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement

• Published in: Gastrointestinal endoscopy 2007-08, Vol.66 (2), p.277-282
• Main Authors: Savides, Thomas J., MD, Donohue, Michael, PhD, Hunt, Gordon, MD, Al-Haddad, Mohammed, MD, Aslanian, Harry, MD, Ben-Menachem, Tamir, MD, Chen, Victor K., MD MSPH, Walter Coyle, MD, Deutsch, John, MD, DeWitt, John, MD, Dhawan, Manish, MD, Eckardt, Alexander, MD, Eloubeidi, Mohamad, MD, Esker, Alec, MD, Gordon, Stuart R., MD, Gress, Frank, MD, Ikenberry, Steven, MD, Joyce, Ann Marie, MD, Klapman, Jason, MD, Lo, Simon, MD, Maluf-Filho, Fauze, MD, Nickl, Nicholas, MD, Singh, Virmeet, MD, Wills, Jason, MD, Behling, Cynthia, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Cytodiagnosis; Endosonography; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Pancreatic Neoplasms - diagnosis; Sensitivity and Specificity; Ultrasonography, Interventional
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2007.01.017

Background The diagnostic yield of EUS-guided FNA (EUS-FNA) of solid pancreatic masses is a potential benchmark for EUS-FNA quality, because the majority of EUS-FNA of solid pancreatic masses should be diagnostic for malignancy. Objectives To determine the cytologic diagnostic rate of malignancy in EUS-FNA of solid pancreatic masses and to determine if variability exists among endoscopists and centers. Design Multicenter retrospective study. Patients EUS centers provided cytology reports for all EUS-FNAs of solid, noncystic, ≥10-mm-diameter, solid pancreatic masses during a 1-year period. Main Outcome Measurement Cytology diagnostic of pancreatic malignancy. Results A total of 1075 patients underwent EUS-FNA at 21 centers (81% academic) with 41 endoscopists. The median number of EUS-FNA of solid pancreatic masses performed during the year per center was 46 (range, 4-177) and per endoscopist was 19 (range, 1-97). The mean mass dimensions were 32 × 27 mm, with 73% located in the head. The mean number of passes was 3.5. Of the centers, 90% used immediate cytologic evaluation. The overall diagnostic rate of malignancy was 71%, 95% confidence interval 0.69%-0.74%, with 5% suspicious for malignancy, 6% atypical cells, and 18% negative for malignancy. The median diagnostic rate per center was 78% (range, 39%-93%; 1st quartile, 61%) and per endoscopist was 75% (range, 0%-100%; 1st quartile, 52%). Limitations Retrospective study, participation bias, and varying chronic pancreatitis prevalence. Conclusions (1) EUS-FNA cytology was diagnostic of malignancy in 71% of solid pancreatic masses and (2) endoscopists with a final cytologic diagnosis rate of malignancy for EUS-FNA of solid masses that was less than 52% were in the lowest quartile and should evaluate reasons for their low yield.