Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 21;14(14):3544.
doi: 10.3390/cancers14143544.

Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors

Thomas Togliani  1   2 , Andrea Lisotti  3 , Rosa Rinaldi  4 , Adele Fornelli  5 , Stefano Pilati  1 , Nicola Passigato  2 , Pietro Fusaroli  3
Affiliations

Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors

Thomas Togliani et al. Cancers (Basel). .

Abstract

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) of solid pancreatic tumors shows optimal specificity despite fair sensitivity, with an overall suboptimal diagnostic yield. We aim to quantify the adequacy and accuracy of EUS-TA and assess predictive factors for success, focusing on the presence and degree of specimen fibrosis. All consecutive EUS-TA procedures were retrieved, and the specimens were graded for sample adequacy and fibrosis. The results were evaluated according to patients' and tumor characteristics and the EUS-TA technique. In total, 407 patients (59% male, 70 [63-77] year old) were included; sample adequacy and diagnostic accuracy were 90.2% and 94.7%, respectively. Fibrosis was significantly more represented in tumors located in the head/uncinate process (p = 0.001). Tumor location in the head/uncinate (OR 0.37 [0.14-0.99]), number of needle passes ≥ 3 (OR 4.53 [2.22-9.28]), and the use of cell block (OR 8.82 [3.23-23.8]) were independently related to adequacy. Severe fibrosis was independently related to false negative results (OR 8.37 [2.33-30.0]). Pancreatic tumors located in the head/uncinate process showed higher fibrosis, resulting in EUS-TA with lower sample adequacy and diagnostic accuracy. We maintain that three or more needle passes and cell block should be done to increase the diagnostic yield.

Keywords: adequacy; endoscopic ultrasonography (EUS); fibrosis; fine needle aspiration (FNA); fine needle biopsy (FNB); pancreas.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Adequacy score. (A): inadequate specimen (exclusively blood sample devoid of epithelial cellularity). (B): low cellularity (a small aggregate of epithelial cells in blood sample). (C): moderate cellularity (a clearly visible cellular cluster with preserved architecture, without atypia). (D): rich cellularity (cellular neoplastic clusters with atypical hyperchromic nuclei, punctiform necrosis, and apoptotic bodies).
Figure 2
Figure 2
Fibrosis score. (A): fibrosis grade 0 (cellular neoplastic clusters; total absence of fibrous tissue). (B): fibrosis grade 1 (wispy, loose density fibrous tissue with admixture of moderate cellular epithelial component). (C): fibrosis grade 2 (clearly visible loose fibrous tissue fragment; absence of epithelial component).
See this image and copyright information in PMC

References

    1. Gkolfakis P., Crinò S.F., Tziatzios G., Ramai D., Papaefthymiou A., Papanikolaou I.S., Triantafyllou K., Arvanitakis M., Lisotti A., Fusaroli P., et al. Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: A network meta-analysis. Gastrointest. Endosc. 2022;95:1067–1077. doi: 10.1016/j.gie.2022.01.019. - DOI - PubMed
    1. Kitano M., Minaga K., Hatamaru K., Ashida R. Clinical dilemma of endoscopic ultrasound-guided fine needle aspiration for resectable pancreatic body and tail cancer. Dig. Endosc. 2022;34:307–316. doi: 10.1111/den.14120. - DOI - PubMed
    1. Lisotti A., Frazzoni L., Fuccio L., Serrani M., Cominardi A., Bazzoli F., Fusaroli P. Repeat EUS-FNA of pancreatic masses after nondiagnostic or inconclusive results: Systematic review and meta-analysis. Gastrointest. Endosc. 2020;91:1234–1241. doi: 10.1016/j.gie.2020.01.034. - DOI - PubMed
    1. Khoury T., Kadah A., Farraj M., Barhoum M., Livoff A., Mari A., Mahamid M., Sbeit W. The role of rapid on-site evaluation on diagnostic accuracy of endoscopic ultrasound fine needle aspiration for pancreatic, submucosal upper gastrointestinal tract and adjacent lesions. Cytopathology. 2019;30:499–503. doi: 10.1111/cyt.12712. - DOI - PubMed
    1. Iglesias-Garcia J., Dominguez-Munoz J.E., Abdulkader I., Larino-Noia J., Eugenyeva E., Lozano-Leon A., Forteza-Vila J. Influence of on-site 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. doi: 10.1038/ajg.2011.119. - DOI - PubMed

LinkOut - more resources