Factors Determining Diagnostic Yield of Endoscopic Ultrasound Guided Fine-Needle Aspiration for Pancreatic Cystic Lesions: A Multicentre Asian Study |
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Authors: | Lee Guan Lim Sandeep Lakhtakia Tiing Leong Ang Charles K F Vu Frederick Dy Vui Heng Chong Christopher J L Khor Wee Chian Lim Bhavesh Kishor Doshi Shyam Varadarajulu Kenjiro Yasuda Jennie Y Y Wong Yiong Huak Chan Min En Nga Khek Yu Ho |
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Institution: | 1. Department of Gastroenterology and Hepatology, National University Health System, 10 Kent Ridge Crescent, Singapore, 119260, Singapore 2. Asian Institute of Gastroenterology, Hyderabad, India 3. Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore 4. Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore, Singapore 5. University Santo Tomas Hospital, Manila, Philippines 6. Department of Medicine, RIPAS Hospital, Brunei Darussalam, Brunei 7. Basil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA 8. Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan 9. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore 10. Biostatistics Unit, National University Health System, Singapore, Singapore 11. Department of Pathology, National University Health System, Singapore, Singapore
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Abstract: | Background and Aim The purpose of this study was to determine (1) the diagnostic yield for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with pancreatic cystic lesions, (2) additional value of EUS-FNA over EUS alone in the diagnosis of pancreatic cysts, and (3) diagnostic sensitivity and specificity of EUS and EUS-FNA in the subset of patients where histopathology of surgical specimens were available. Methods All patients who underwent EUS examination for the evaluation of pancreatic cystic lesions in six Asian centres were included in the study. Results Of 298 patients with pancreatic cysts who underwent EUS, 132 (44.3 %) underwent FNA. In the entire cohort, pseudocysts and intraductal papillary mucinous neoplasm (IPMN) were the predominant cystic lesions. The cytologic yield of EUS-FNA was 47 %. On univariate analysis, factors associated with higher cytologic yield included vascular involvement on EUS, presence of solid cystic component, and increased number of needle passes during EUS-FNA. On multivariate analysis, presence of solid cystic components and increased number of needle passes during EUS-FNA were associated with higher diagnostic yield of EUS-FNA. For pancreatic cysts with a solid component, the diagnostic yield of EUS-FNA increased significantly from 44 % with one pass to 78 % with more than one pass (p = 0.016). In the absence of a solid component, the diagnostic yield was 29 % with one pass and was not significantly different from the diagnostic yield of 50 % with more than one pass, p = 0.081. Conclusion The cytologic yield of EUS-FNA was 47 %. When a solid component was present in the cyst, doing more than one pass during EUS-FNA increased its diagnostic yield. |
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