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Lower Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Head Mass with a Biliary Stent

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Abstract

Background

In jaundiced patients with suspected pancreatic cancer, endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent is frequently performed prior to histologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).

Aims

To compare the accuracy of jaundiced patients undergoing EUS-FNA for a pancreatic mass with or without a biliary stent.

Methods

Consecutive patients with a pancreatic mass and jaundice who underwent EUS-FNA between 4/2005 and 4/2013 were identified. Final diagnosis was based on histologic or radiologic evaluation with >6-month follow-up if the index EUS-FNA was negative for malignancy. Primary endpoint was histologic accuracy of EUS-FNA.

Results

Mean age of the 180 patients was 65 ± 12 years; 83 (46 %) had ERCP prior to EUS-FNA and 75 (42 %) received a biliary stent. Onsite cytopathologist was present for 81 (45 %) procedures. Final diagnosis revealed malignancy in 172 (96 %) patients, with adenocarcinoma in 159 (88 %). Patients with biliary stents had lower accuracy of EUS-FNA for malignancy than those without a biliary stent: 77 % (95 % CI 67–85 %) versus 89 % (95 % CI 81–93 %). On multivariate analysis, having a biliary stent (OR = 0.37, 95 % CI 0.15–0.90), onsite cytopathologist (OR = 9.24, 95 % CI 2.64–32.37), and receiving a core biopsy (OR = 2.60, 95 % CI 1.07–6.29) were associated with accuracy of EUS-FNA.

Conclusions

Presence of a biliary stent was associated with a significant decrease in the accuracy of EUS-FNA for histologic diagnosis of pancreatic cancer, while accuracy was increased when a cytopathologist was onsite. EUS-FNA should be performed prior to ERCP in jaundiced patients with suspected pancreatic cancer.

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Abbreviations

EUS-FNA:

Endoscopic ultrasound-guided fine-needle aspiration

ERCP:

Endoscopic retrograde cholangiopancreatography

CBD:

Common bile duct

References

  1. American Cancer Society. Cancer Facts & Figures 2013. Atlanta: American Cancer Society; 2013.

  2. Porta M, Fabregat X, Malats N, et al. Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. ClinTranslOncol. 2005;7:189–197.

    Google Scholar 

  3. Eloubeidi MA, Jhala D, Chieng DC, et al. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer. 2003;99:285–292.

    Article  PubMed  Google Scholar 

  4. Puli SR, Bechtold ML, Buxbaum JL, et al. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass? A meta-analysis and systematic review. Pancreas. 2013;42:20–26.

    Article  PubMed  Google Scholar 

  5. Savides TJ, Donohue M, Hunt G, et al. EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement. Gastrointest Endosc. 2007;66:277–282.

    Article  PubMed  Google Scholar 

  6. Iglesias-Garcia J, Dominguez-Munoz JE, et al. Influence of onsite cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol. 2011;106:1705–1710.

    Article  PubMed  Google Scholar 

  7. Krishna NB, Mehra M, Reddy AV, et al. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc. 2009;70:70–79.

    Article  PubMed  Google Scholar 

  8. National Institutes of Health. State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14–16; 2002.

  9. Ranney N, Phadnis M, Trevino J, et al. Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions. Gastrointest Endosc. 2012;76:76–83.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Fisher J, Gordon S, Gardner T. The impact of prior biliary stenting on the accuracy and complicate rate of endoscopic ultrasound fine-needle aspiration for diagnosing pancreatic adenocarcinoma. Pancreas. 2011;40:21–24.

    Article  PubMed  Google Scholar 

  11. Van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–137.

    Article  PubMed  Google Scholar 

  12. Siddiqui AA, Fein M, Kowalski TE, et al. Comparison of the influence of plastic and fully covered metal biliary stents on the accuracy of EUS-FNA for the diagnosis of pancreatic cancer. Dig Dis Sci. 2012;57:2438–2445.

    Article  CAS  PubMed  Google Scholar 

  13. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251–1261.

    Article  PubMed  Google Scholar 

  14. Fusaroli P, Manta R, Fedeli P, et al. The influence of endoscopic biliary stents on the accuracy of endoscopic ultrasound for pancreatic head cancer staging. Endoscopy. 2007;39:813–817.

    Article  CAS  PubMed  Google Scholar 

  15. Bao PQ, Johnson JC, Lindsey EH, et al. Endoscopic ultrasound and computed tomography predictors of pancreatic cancer resectability. J Gastrointest Surg. 2008;12:10–16.

    Article  PubMed  Google Scholar 

  16. Cannon ME, Carpenter SL, Elta GH, et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc. 1999;50:27–33.

    Article  CAS  PubMed  Google Scholar 

  17. Euscher ED, Marsh WL Jr, Lucas JG, et al. Histologic and immunohistochemical changes in the stented common bile duct. Appl Immunohistochem Mol Morphol. 2007;15:299–304.

    Article  PubMed  Google Scholar 

  18. Hébert-Magee S, Bae S, Varadarajulu S, et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology. 2013;24:159–171.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bang JY, Hebert-Magee S, Trevino J, et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc. 2012;76:321–327.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Pancreatic Section of the British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, et al. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut. 2005;54:1–16.

  21. Dumonceau JM, Koessler T, van Hooft JE, et al. Endoscopic ultrasonography-guided fine needle aspiration: relatively low sensitivity in the endosonographer population. World J Gastroenterol. 2012;18:2357–2363.

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

None of the authors have conflict of interest or funding source to declare to complete this study.

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Authors and Affiliations

  1. Division of Gastroenterology, Loma Linda University Medical Center, 11234 Anderson Street, Room 1556, Loma Linda, CA, 92354, USA

    John J. Kim, Sukhpreet Walia, Scott H. Lee, Bhavesh Patel, Madhavi Vetsa, Yan Zhao & Wichit Srikureja

  2. Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China

    John J. Kim

  3. Section of Digestives Diseases, Yale University School of Medicine, 333 Cedar St./1080 LMP, New Haven, CT, 06520-8019, USA

    Loren Laine

  4. VA Connecticut Healthcare System, West Haven, CT, USA

    Loren Laine

Authors
  1. John J. Kim
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  2. Sukhpreet Walia
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  3. Scott H. Lee
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  4. Bhavesh Patel
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  5. Madhavi Vetsa
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  6. Yan Zhao
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  7. Wichit Srikureja
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  8. Loren Laine
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Correspondence to John J. Kim.

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Kim, J.J., Walia, S., Lee, S.H. et al. Lower Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Head Mass with a Biliary Stent. Dig Dis Sci 60, 543–549 (2015). https://doi.org/10.1007/s10620-014-3367-0

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  • DOI: https://doi.org/10.1007/s10620-014-3367-0

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