How to improve the success of endoscopic ultrasound guided fine needle aspiration cytology in the diagnosis of pancreatic lesions

Abstract

Endoscopic ultrasonography (EUS) is highly accurate for assessing the pancreatic parenchyma and ductal system. Currently, it is the most sensitive imaging procedure for detecting small solid pancreatic masses. EUS-guided fine needle aspiration cytology (EUS-FNA) is a safe and highly accurate tool for the diagnosis of pancreatic malignancy. Prior to perform an EUS-FNA one should wonder whether the benefits outweigh the potential risks of the procedure. Therefore, it is important to take into account whether the procedure will influence patient management. The diagnostic yield and success rate of EUS-FNA in pancreatic lesions varies greatly depending on many factors including: the characteristics of the lesion itself (location of the mass and consistency of the lesion), technical factors (type of needle size, use of stylet, use of suction and number of needle passes performed) and the availability of immediate cytological assessment of the specimen. The aim of this review is to analyze all these factors for optimizing specimen collection and diagnostic efficiency in dealing with solid pancreatic masses.

Keywords: diagnosis; endoscopic ultrasound guided fine needle aspiration cytology; pancreatic lesions.

Figure 1

EUS-FNA in the diagnosis of pancreatic neoplasms. * Preferable EUS-FNA; ** Avoid EUS-FNA as a general rule in body and tail lesions. Reconsider EUS FNA when a different lesion to a pancreatic adenocarcinoma is suspected (i.e. pancreatic mass in young patients, atypical symptoms, personal history of tumors).

Figure 2

Echoendoscope in short loop position. Notice that there is no fulcurm during fine needle aspiration cytology.

Figure 3

Echoendoscope in long loop position. The gastric and duodenal walls work as fulcurm during the fine needle aspiration cytology (arrowheads).