PURPOSE: To investigate the value of EUS-guided FNA in the diagnosis of solid and cystic pancreatic tumor(-like) lesions as well as metastatic tumor growth within peripancreatic lymph nodes and its impact on therapeutic decision-making. The results of the cytologic and pathohistological investigation were compared with i) each other and ii) the detection rates of various imaging procedures. PATIENTS AND METHODS: Overall, 153 patients (mean age, 56.9 years) underwent EUS-guided FNA from I/ 2000 - III/ 2003. RESULTS: Comparing various imaging procedures such as CT scan (80 %), MRI (57.1 %) and abdominal US (88.8 %), EUS achieved the highest diagnostic accuracy: 100 %. For EUS-based T-staging in 26 patients with malignant tumor lesions undergoing surgical intervention, there was a sensitivity of 73.3 % (specificity, 85.9 %; PPV, 69.2 %; NPV, 84.4 %), while the parameters for N-staging (n = 25) were: sensitivity, 61.5 %; specificity, 75 %; NPV, 64.3 %; PPV, 72.7 %. While the sensitivity of EUS-guided FNA in the group of patients who underwent surgical intervention (n = 55) was 81.4 % (specificity, 75 %; PPV, 92.1 %; NPV, 52.9 %), the parameters were as follows in the subgroup of individuals with chronic pancreatitis (n = 30): sensitivity in detecting a malignant pancreatic tumor lesion, 50 %; specificity, 91.7 %; PPV, 60 %; NPV, 88 %. Based on preoperative characteristics such as suspected diagnosis, TNM stage and tumor entity, a surgical intervention could be avoided in 29 / 153 patients (19 %). CONCLUSION: EUS-guided FNA allows more precise diagnosis clarification (malignant tumor growth and tumor entity) in solid and cystic pancreatic tumor(-like) lesions, which may assist in early and sufficient therapeutic decision-making. Georg Thieme Verlag KG Stuttgart . New York.
PURPOSE: To investigate the value of EUS-guided FNA in the diagnosis of solid and cystic pancreatic tumor(-like) lesions as well as metastatic tumor growth within peripancreatic lymph nodes and its impact on therapeutic decision-making. The results of the cytologic and pathohistological investigation were compared with i) each other and ii) the detection rates of various imaging procedures. PATIENTS AND METHODS: Overall, 153 patients (mean age, 56.9 years) underwent EUS-guided FNA from I/ 2000 - III/ 2003. RESULTS: Comparing various imaging procedures such as CT scan (80 %), MRI (57.1 %) and abdominal US (88.8 %), EUS achieved the highest diagnostic accuracy: 100 %. For EUS-based T-staging in 26 patients with malignant tumor lesions undergoing surgical intervention, there was a sensitivity of 73.3 % (specificity, 85.9 %; PPV, 69.2 %; NPV, 84.4 %), while the parameters for N-staging (n = 25) were: sensitivity, 61.5 %; specificity, 75 %; NPV, 64.3 %; PPV, 72.7 %. While the sensitivity of EUS-guided FNA in the group of patients who underwent surgical intervention (n = 55) was 81.4 % (specificity, 75 %; PPV, 92.1 %; NPV, 52.9 %), the parameters were as follows in the subgroup of individuals with chronic pancreatitis (n = 30): sensitivity in detecting a malignant pancreatic tumor lesion, 50 %; specificity, 91.7 %; PPV, 60 %; NPV, 88 %. Based on preoperative characteristics such as suspected diagnosis, TNM stage and tumor entity, a surgical intervention could be avoided in 29 / 153 patients (19 %). CONCLUSION: EUS-guided FNA allows more precise diagnosis clarification (malignant tumor growth and tumor entity) in solid and cystic pancreatic tumor(-like) lesions, which may assist in early and sufficient therapeutic decision-making. Georg Thieme Verlag KG Stuttgart . New York.
Authors: Lawrence Mj Best; Vishal Rawji; Stephen P Pereira; Brian R Davidson; Kurinchi Selvan Gurusamy Journal: Cochrane Database Syst Rev Date: 2017-04-17