Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) has been reported to provide a more accurate diagnosis than EUS-FNA without such evaluation. However, even endosonographers can evaluate ROSE regarding sample adequacy. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers compared to ROSE by cytopathologists in patients with solid pancreatic masses.

Methods

Between September 2001 and October 2005, of the 73 EUS-FNA procedures with the final diagnoses, 38 procedures after the introduction of ROSE by endosonographers (September 2001–September 2003, period 1), and 35 procedures after the introduction of ROSE by cytopathologists (October 2003–October 2005, period 2) were included. The specimens were stained with Diff-Quik stain and assessed. When the on-site assessors (endosonographers or cytopathologists) indicated that the amounts of cell samples were adequate, the procedure was stopped.

Results

Results are presented with 95% confidence limits. The average numbers of needle passes were 4.0 ± 1.6 and 3.4 ± 1.5 in periods 1 and 2, respectively (P = 0.06). The specimen collection rates were 97.4 and 97.1% in periods 1 and 2, respectively (P = 0.51). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy and benign were 92.9, 100, 100, 83.3, and 94.7%, respectively, in period 1, and 93.1, 100, 100, 75.0, and 94.3%, respectively, in period 2 (P = 0.97, P = 1.0, P = 1.0, P = 0.65, P = 0.93, respectively). No complications were seen.

Conclusions

For accurate diagnosis, ROSE should be performed during EUS-FNA by the endosonographer, if no cytopathologist is available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vilmann P, Jacobsen GK, Henrikse FW, Hancke S. Endoscopic ultrasound with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992;38:172–3.

    Article  PubMed  CAS  Google Scholar 

  2. Wakatsuki T, Irisawa A, Bhutani MS, Hikichi T, Shibukawa G, Takagi T, et al. A comparative study of diagnostic value of cytologic sampling by endoscopic ultrasonography-guided fine-needle aspiration and that by endoscopic retrograde pancreatography for the management of pancreatic mass without biliary stricture. J Gastroenterol Hepatol. 2005;20:1701–11.

    Article  Google Scholar 

  3. Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, van Velse A, Osborne JF, et al. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy. 1997;29:854–8.

    Article  PubMed  CAS  Google Scholar 

  4. Mallery JS, Centeno BA, Hahn PF, Chang Y, Warshaw AL, Brugge WR. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc. 2002;56:218–24.

    Article  PubMed  Google Scholar 

  5. Erickson RA. EUS-guided FNA. Gastrointest Endosc. 2004;60:267–79.

    Article  PubMed  Google Scholar 

  6. Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc. 2000;51:184–90.

    Article  PubMed  CAS  Google Scholar 

  7. Chang KJ, Katz KD, Durbin TE, Erickson RA, Butler JA, Lin F, et al. Endoscopic ultrasound-guided fine-needle aspiration. Gastrointest Endosc. 1994;40:694–9.

    PubMed  CAS  Google Scholar 

  8. Chang KJ. Maximizing the yield of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2002;56:S28–34.

    Article  PubMed  Google Scholar 

  9. Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997;45:387–93.

    Article  PubMed  CAS  Google Scholar 

  10. Chang KJ. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic tumors. Gastrointest Endosc Clin N Am. 1995;5:723–34.

    PubMed  CAS  Google Scholar 

  11. Tada M, Komatsu Y, Kawabe T, Sasahira N, Isayama H, Toda N, et al. Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasound-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor. Am J Gastroenterol. 2002;97:1386–90.

    Article  Google Scholar 

  12. Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endoscopic ultrasound-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997;112:1087–95.

    Article  PubMed  CAS  Google Scholar 

  13. Wiersema MJ, Kochman ML, Cramer HM, Tao LC, Wiersema LM. Endosonography-guided real-time fine-needle aspiration biopsy. Gastrointest Endosc. 1994;40:700–7.

    PubMed  CAS  Google Scholar 

  14. Takahashi K, Yamao K, Okubo K, Sawaki A, Mizuno N, Ashida R, et al. Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA. Gastrointest Endosc. 2005;61:76–9.

    Article  PubMed  Google Scholar 

  15. Raut CP, Grau AM, Staerkel GA, Kaw M, Tamm EP, Wolff RA, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg. 2003;7:118–28.

    Article  PubMed  Google Scholar 

  16. Yamao K, Sawaki A, Mizuno N, Shimizu Y, Yatabe Y, Koshikawa T. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future. J Gastroenterol. 2005;40:1013–23.

    Article  PubMed  Google Scholar 

  17. LeBlanc JK, Ciaccia D, Al-Assi MT, McGrath K, Imperiale T, Tao L-C, et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc. 2004;59:475–81.

    Article  PubMed  Google Scholar 

  18. Harewood GC, Wiersema LM, Hailing AC, Keeney GL, Salamao DR, Wiersema MJ. Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses. Gastrointest Endosc. 2002;55:669–73.

    Article  PubMed  Google Scholar 

  19. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic mass. Am J Gastroenterol. 2002;97:1386–91.

    Article  PubMed  Google Scholar 

  20. Gress F, Michael H, Gelrud D, Patel P, Gottlieb K, Singh F, et al. EUS-guided fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication. Gastrointest Endosc. 2002;56:864–7.

    Article  PubMed  Google Scholar 

  21. Gress FG, Hawes RH, Savides TJ, Ikenberry SO, Lehman GA. Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography. Gastrointest Endosc. 1997;45:243–50.

    Article  PubMed  CAS  Google Scholar 

  22. Erickson RA, Garza AA. EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice. Gastrointest Endosc. 2001;53:475–84.

    Article  PubMed  CAS  Google Scholar 

  23. Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute 30-day complications. Am J Gastroenterol. 2003;98:2663–8.

    PubMed  Google Scholar 

  24. O’Toole D, Palazzo L, Arotcarena R, Dancour A, Aubert A, Hammel P, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001;53:470–4.

    Article  PubMed  Google Scholar 

  25. Eloubeidi MA, Gress FG, Savides TJ, Wiersema MJ, Kochman ML, Ahmad NA, et al. Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS center in the United States. Gastrointest Endosc. 2004;60:385–9.

    Article  PubMed  Google Scholar 

  26. Eloubeidi MA, Tamhane A, Varadarajulu S, Wilcox CM. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc. 2006;63:622–9.

    Article  PubMed  Google Scholar 

  27. Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB. Pancreatic FNA in 1000 cases: a comparison of imaging modalities. Gastrointest Endosc. 2005;61:854–61.

    Article  PubMed  Google Scholar 

  28. Binmoeller KF, Rathod VD. Difficult pancreatic mass FNA: tips for success. Gastrointest Endosc. 2002;56:S86–93.

    Article  PubMed  Google Scholar 

  29. Micames C, Jowell PS, White R, Paulson E, Nelson R, Morse M, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003;58:690–5.

    Article  PubMed  Google Scholar 

  30. Eloubeidi MA, Tamhane A. EUS-guided FNA of solid pancreatic masses: a learning curve with 300 consecutive procedures. Gastrointest Endosc. 2005;61:700–8.

    Article  PubMed  Google Scholar 

  31. Mertz H, Gautam S. The learning curve for EUS-guided FNA of pancreatic cancer. Gastrointest Endosc. 2004;59:33–7.

    Article  PubMed  Google Scholar 

  32. Logrono R, Waxman I. Interactive role of the cytopathologists in EUS-guided fine needle aspiration: an effective approach. Gastrointest Endosc. 2001;54:485–90.

    Article  PubMed  CAS  Google Scholar 

  33. Klapman JB, Logrono R, Dye CE, Waxman I. Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol. 2003;98:1289–94.

    Article  PubMed  Google Scholar 

  34. Silverman JF, Frable WJ. The use of the Diff-Quik stain in the immediate interpretation of fine-needle aspiration biopsies. Diagn Cytopathol. 1990;6:366–9.

    Article  PubMed  CAS  Google Scholar 

  35. Suen KC, Abdul-Karim FW, Kaminsky DB, Layfield LJ, Miller TR, Spires SE, et al. Guidelines of the Papanicolaou Society of Cytopathology for fine needle aspiration procedure and reporting: the Papanicolaou Society of Cytology Task Force on Standards of Practice. Diagn Cytopathol. 1997;17:239–47.

    Article  Google Scholar 

  36. Savoy AD, Raimondo M, Woodward TA, Noh K, Pungpapong S, Jones AD, et al. Can endosonographers evaluate on-site cytologic adequacy? A comparison with cytotechnologists. Gastrointest Endosc. 2007;65:953–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine II, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan

    Takuto Hikichi, Atsushi Irisawa, Tadayuki Takagi, Goro Shibukawa, Go Yamamoto, Takeru Wakatsuki, Hidemichi Imamura, Yuta Takahashi, Ai Sato, Masaki Sato, Tsunehiko Ikeda & Hiromasa Ohira

  2. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan

    Takuto Hikichi & Katsutoshi Obara

  3. Department of Gastroenterology, Hepatology and Nutrition, UT MD Anderson Cancer Center, Houston, TX, USA

    Manoop S. Bhutani

  4. Department of Pathology, Fukushima Medical University Hospital, Fukushima, Japan

    Yuko Hashimoto, Kazuhiro Tasaki & Kazuo Watanabe

Authors
  1. Takuto Hikichi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Irisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manoop S. Bhutani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tadayuki Takagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Goro Shibukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Go Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takeru Wakatsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hidemichi Imamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuta Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ai Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masaki Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tsunehiko Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yuko Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kazuhiro Tasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kazuo Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Hiromasa Ohira
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Katsutoshi Obara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Atsushi Irisawa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hikichi, T., Irisawa, A., Bhutani, M.S. et al. Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol 44, 322–328 (2009). https://doi.org/10.1007/s00535-009-0001-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-009-0001-6

Keywords

Search

Navigation