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. 2020 Mar;32(3):399-408.
doi: 10.1111/den.13497. Epub 2019 Sep 15.

Features of chronic pancreatitis by endoscopic ultrasound influence the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration of small pancreatic lesions

Yusuke Kurita  1   2 , Takamichi Kuwahara  1 , Kazuo Hara  1 , Nobumasa Mizuno  1 , Nozomi Okuno  1 , Shimpei Matsumoto  1 , Masahiro Obata  1 , Hiroki Koda  1 , Masahiro Tajika  3 , Yasuhiro Shimizu  4 , Atsushi Nakajima  2 , Kensuke Kubota  2 , Yasumasa Niwa  3
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Features of chronic pancreatitis by endoscopic ultrasound influence the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration of small pancreatic lesions

Yusuke Kurita et al. Dig Endosc. 2020 Mar.

Abstract

Background and aim: In chronic pancreatitis (CP) patients, diagnosis of small pancreatic lesions by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is challenging. Thus, the aim of the present study was to investigate whether CP influences the diagnostic ability of EUS-FNA for pancreatic lesions ≤10 mm.

Methods: One hundred and seventeen patients who underwent EUS-FNA for pancreatic lesions ≤10 mm in size were enrolled. Patients were classified into two groups based on features of CP observed by EUS (EUS-CP features) in accordance with the Rosemont classification. The CP group was defined as cases consistent with CP or suggestive of CP, and the non-CP group was defined as cases indeterminate for CP or normal. Factors influencing the diagnostic accuracy of EUS-FNA and CP status in pancreatic tumors were also investigated.

Results: Diagnostic ability of EUS-FNA (overall cases, non-CP vs CP) had sensitivity (80.4%, 96.7% vs 57.1%; P < 0.001), specificity (100%, 100% vs 100%; P > 0.05), and accuracy (91.5%, 98.6% vs 80.4%; P = 0.001). In multivariate analysis of factors influencing the accuracy of EUS-FNA, CP significantly lowered the accuracy (P = 0.048; odds ratio [OR] = 9.21). Among pancreatic cancer patients, the number of CP patients was significantly higher than the number of patients with benign lesions (P = 0.023). In multivariate analysis, lobularity without honeycombing was more frequently observed in cases of pancreatic cancer (P = 0.018; OR, 12.65).

Conclusion: Endoscopic ultrasound-guided FNA offers high accuracy for small pancreatic lesions ≤10 mm. However, in cases with CP, the diagnostic ability of EUS-FNA is significantly reduced.

Keywords: chronic pancreatitis; endoscopic ultrasound; endoscopic ultrasound-guided fine-needle aspiration; pancreatic cancer; rosemont classification.

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