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Impact of calcifications on diagnostic yield of endoscopic ultrasound–guided fine-needle aspiration for pancreatic ductal adenocarcinoma

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Abstract

Introduction

Chronic calcific pancreatitis (CCP) is a major risk factor for pancreatic ductal adenocarcinoma (PDAC) and is common in southern India. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is useful for tissue acquisition in patients with solid pancreatic lesions. Multiple factors may affect the diagnostic yield of FNA samples. The present study was performed to assess the impact of pancreatic calcifications on the diagnostic yield of EUS-FNA in PDAC.

Methods

All patients with confirmed PDAC from January 2013 to December 2017 were included. CCP was diagnosed based on typical imaging characteristics with or without evidence of pancreatic insufficiency along with surgical histopathology reports showing features of chronic pancreatitis. The diagnostic yield and adequacy of cellularity were  assessed by a pathologist who was blinded and were compared between the two groups: group 1: PDAC patients with no evidence of CCP and, group 2: PDAC patients with CCP.

Results

A total of 122 patients were included in the study. The diagnostic yield was lower in patients in group 2 (n = 42, 25 [59.52%]) as compared to those in group 1 (n = 80, 63 [78.75%]) (p-value = 0.01). On multivariate analysis, only the presence of calcifications was found to have an independent association with diagnostic yield (odds ratio 3.83 [95% confidence interval 1.22–11.9]).

Conclusions

CCP had a significant impact on the diagnostic yield of EUS-FNA for pancreatic adenocarcinoma. Novel techniques and newer technology that may mitigate the negative effect of calcification on diagnostic yield of EUS-FNA in patients with CCP.

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Authors and Affiliations

  1. Department of Gastroenterology, Amrita Institute of Medical Sciences, AIMS PO, Ponekkara, Kochi, 682 041, India

    Anoop K Koshy, Rao B Harshavardhan, Ismail Siyad & Rama P Venu

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  1. Anoop K Koshy
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  2. Rao B Harshavardhan
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  3. Ismail Siyad
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  4. Rama P Venu
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Contributions

Harshavardhan Rao B performed the data entry and analysis. Anoop K Koshy and Harshavardhan Rao B then prepared the manuscript. Ismail Siyad and Rama P Venu revised the article critically for important intellectual content.

Corresponding author

Correspondence to Rama P Venu.

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AKK, RBH, IS, and RPV declare that they have no conflict of interest.

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The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Koshy, A.K., Harshavardhan, R.B., Siyad, I. et al. Impact of calcifications on diagnostic yield of endoscopic ultrasound–guided fine-needle aspiration for pancreatic ductal adenocarcinoma. Indian J Gastroenterol 38, 128–133 (2019). https://doi.org/10.1007/s12664-019-00941-y

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  • DOI: https://doi.org/10.1007/s12664-019-00941-y

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