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. 2016 Sep;51(9):923-30.
doi: 10.1007/s00535-016-1164-6. Epub 2016 Jan 14.

Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms

Susumu Hijioka  1 , Kazuo Hara  2 , Nobumasa Mizuno  2 , Hiroshi Imaoka  2 , Vikram Bhatia  3 , Mohamed A Mekky  4 , Kenichi Yoshimura  5 , Tsukasa Yoshida  2 , Nozomi Okuno  2 , Nobuhiro Hieda  2 , Masahiro Tajika  6 , Tsutomu Tanaka  6 , Makoto Ishihara  6 , Yasushi Yatabe  7 , Yasuhiro Shimizu  8 , Yasumasa Niwa  6 , Kenji Yamao  2
Affiliations

Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms

Susumu Hijioka et al. J Gastroenterol. 2016 Sep.

Abstract

Background: Multiple studies have investigated sampling adequacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic neuroendocrine neoplasms (pNENs). However, none have described the diagnostic performance of EUS-FNA for pNENs, or the influencing factors. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA, with post-operative pathological diagnosis as the gold standard, and factors predictive of inadequate EUS sampling.

Methods: From 1998 to 2014, a total of 698 patients underwent pancreatic resection and 1455 patients underwent EUS-FNA sampling for pancreatic lesions. A total of 410 cases underwent both surgical resection and preceding EUS-FNA. Of these, 60 cases (49 true pNEN, nine non-diagnostic, two misdiagnoses) were included. We studied diagnostic performance of EUS-FNA and factors that were associated with failed diagnosis.

Results: Of the 60 cases, EUS-FNA yield was 49 true-positive cases, two misdiagnoses, and nine non-diagnostic cases (including six suggestive cases). Sensitivity, specificity, and accuracy were 84.5, 99.4, and 97.3 %, respectively; including the six suggestive cases, diagnostic values were 94.8 % sensitivity (55/58), 99.4 % specificity (350/352), and 98.7 % accuracy (405/410). In multivariate analysis, sampling adequacy rates were significantly lower when lesions were located in the pancreatic head [odds ratio (OR) = 10.0] and in tumor-rich stromal fibrosis (OR = 10.45). Tumor size, needle type, tumor grading, presence of cystic component, and time period were not significant factors.

Conclusions: EUS-FNA offers high accuracy for pNEN. However, location of the tumor in the pancreatic head and presence of rich stromal fibrosis negatively impacts sampling adequacy.

Keywords: Diagnosability; EUS-FNA; Pancreatic neuroendocrine neoplasms.

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Conflict of interest statement

N.M. has received research funding from Taiho Pharmaceutical Co. Ltd., Merck Serono, AstraZeneca, Zeria Pharmaceutical and Takeda Bio Development Center Ltd., and speaking honoraria from Taiho Pharmaceutical Co. Ltd., Elli Lilly Japan K.K., Yakult Honsha Novartis, Phizer and Kyowa-Hakko Kirin, and speakers’ bureau with Taiho Pharmaceutical Co. Ltd.

Figures

Fig. 1
Fig. 1
Algorithm for patient inclusion and exclusion
Fig. 2
Fig. 2
Representative cases of little and rich stromal fibrosis. a, c, e Images of pNEN with little fibrosis. b, d, f Images of pNEN with rich fibrosis. a, b CT shows strong and moderate hypervascularity in the tumor (arrow). c, d T2-weighted imaging shows a hyper- and hypointense mass in the pancreas head (arrow). e, f Low-power image showing weak and numerous fibrosis
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