Research Article
EUS Guided Fine-needle Aspiration (EUS Guided FNA) of Pancreatic Masses: Experiences from the Beginning of the Era and Implications to the Present Day
Rolf D. Klingenberg-Noftz1*, Leimin Sun2, Nils Homann3 and Diether Ludwig4
1Department of Gastroenterology and Internal Medicine, DRK-Hospital Grevesmuehlen, Kluetzer Strasse 13-15, 23939 Grevesmuehlen, Germany
2Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou Zhejiang, China
3Medical Clinic II, Sauerbruchstrasse 7, Wolfsburg Hospital, 38440 Wolfsburg, Germany
4Clinic for Internal Medicine, Segeberg Hospitals, Am Kurpark 1, 2379 Bad Segeberg, Germany
- Corresponding Author:
- Rolf D. Klingenberg-Noftz, MD
Department of Gastroenterology and Internal Medicine
DRK-Hospital Grevesmuehlen, Kluetzer Strasse 13-15
23936 Grevesmuehlen, Germany
Tel: +49 3881 726 601
Fax: +49 3881 726 609
E-mail: rolf.klingenberg-noftz@drk-kh-gvm.de
Received Date: November 23, 2015; Accepted Date: March 23, 2016; Published Date: March 29, 2016
Citation: Klingenberg-Noftz RD, Sun L, Homann N, Ludwig D (2016) EUS Guided Fine-needle Aspiration (EUS Guided FNA) of Pancreatic Masses: Experiences from the Beginning of the Era and Implications to the Present Day. J Gastrointest Dig Syst 6:405. doi:10.4172/2161-069X.1000405
Copyright: © 2016 Klingenberg-Noftz RD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: The work-up of pancreatic mass lesions requires an orchestrated employment of different diagnostic means. The “best”, meaning the most sufficient and goal achieving diagnostic pathway, remains to be established and has to be adopted according to each individual patient. The technique of endoscopic ultrasound (EUS) has been established with a high yield of diagnostic value regarding pancreatic lesions. In combination with fine needle aspirations of the suspected area guided by EUS (EUS guided FNA) the diagnostic value of pancreatic lesions is boosted with regard to the final diagnosis in a clinical setting.
Patients and Methods: During a 36-month period, 142 consecutive patients were referred to us for suspected pancreatic disease and evaluated for this study. Work-up for pancreatic lesions was performed including EUS and EUS-guided FNA. Definite diagnosis was established by explorative/curative laparoscopy/laparotomy or follow-up for up to 36 months in the aftermath of first admission. Results regarding diagnostic precision of EUS guided FNA cytology were evaluated retrospectively and correlated with other diagnostic means performed.
Results: 142 patients underwent work-up for pancreatic mass lesions of unknown genesis. EUS guided FNA was performed in all patients with a total of 13 (9.2%) minor complications (local control achieved), 2 (1.4%) major complications (1× bleeding, 1× perforation) and no fatal complication. Cytology obtained by EUS guided FNA found malignancy in 52(37%) and absence of malignant disease in 70 (49%) cases. Cytology has not rendered a definite result in 20 (14%) cases. Final diagnosis resulted in 42% (n = 59) malignant disease, 42% (n = 60) benign disease, 10 cases (7%) remained without definite diagnosis and 13 patients (9%) left hospitalization or were lost to follow-up before completing the diagnostic work-up. Sensitivity of EUS guided FNA regarding malignant pancreatic disease was 83.7%, the specificity was 95.1% (positive predictive value 93.2%, negative predictive 87.9%).
