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Review
. 2014 Sep;47(5):420-4.
doi: 10.5946/ce.2014.47.5.420. Epub 2014 Sep 30.

Neoplasia in chronic pancreatitis: how to maximize the yield of endoscopic ultrasound-guided fine needle aspiration

Ji Young Bang  1 , Shyam Varadarajulu  1
Affiliations
Review

Neoplasia in chronic pancreatitis: how to maximize the yield of endoscopic ultrasound-guided fine needle aspiration

Ji Young Bang et al. Clin Endosc. 2014 Sep.

Abstract

When performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), identifying neoplasia in the setting of chronic pancreatitis can be technically challenging. The morphology of an ill-defined mass on sonography, presence of calcifications or intervening collaterals, reverberation from a biliary stent, low yield of tissue procurement, and interpretative errors in cytopathology can result in both false-negative and false-positive results. Although these challenges cannot be completely eliminated, elastography or contrast-enhanced imaging can aid in differentiating an inflammatory mass from a neoplasm. Also, performing more passes of FNA, procuring core biopsy material, performing rapid onsite evaluation, conducting ancillary pathology studies, and even repeating the procedure on a different day can aid in improving the diagnostic performance of EUS-FNA. This review provides a concise update and offers practical tips to improving the diagnostic yield of EUS-FNA when sampling solid pancreatic mass lesions in the setting of chronic pancreatitis.

Keywords: Biopsy; Biopsy, fine-needle; Endosonography; Pancreatic neoplasms; Pancreatitis, chronic.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
(A) A hypoechoic mass simulating a neoplasm is observed on linear endosonography. (B) However, a careful examination reveals the mass to be a conglomeration of lobules secondary to chronic pancreatitis.
Fig. 2
Fig. 2
Hyperechoic shadowing by a pancreatic duct stone obscures an underlying pancreatic adenocarcinoma.
Fig. 3
Fig. 3
The presence of collateral vasculature makes tissue acquisition more challenging in chronic pancreatitis.
See this image and copyright information in PMC

References

    1. Fritscher-Ravens A, Brand L, Knöfel WT, et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol. 2002;97:2768–2775. - PubMed
    1. Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc. 2005;62:728–736. - PubMed
    1. Kulesza P, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration: sampling, pitfalls, and quality management. Clin Gastroenterol Hepatol. 2007;5:1248–1254. - PubMed
    1. Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity. Radiologe. 2003;43:850–855. - PubMed
    1. Saftoiu A, Vilman P. Endoscopic ultrasound elastography: a new imaging technique for the visualization of tissue elasticity distribution. J Gastrointestin Liver Dis. 2006;15:161–165. - PubMed

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