Background/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has emerged as a new and effective tool in the evaluation of pancreatic mass lesions. It has proven to be a safe, accurate, and reliable diagnostic procedure and should be performed in centers with experienced gastroenterologists and cytopathologists for optimum results. In this study, we elaborate on our experience of specimen adequacy criteria, overall efficiency of the technique, and the cytomorphologic features of various pancreatic lesions. Patients and Methods: EUS-FNA of the pancreas and subsequent surgical and/or clinical follow-up of all cases performed at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, from November 2006 to January 2010, were retrospectively reviewed. Diff-Quik and Papanicolaou staining methods were used. Immunohistochemistry stains on cell-block preparations were applied whenever available and required. A total of 43 aspirates from 42 patients were available for retrospective review, including 37 (86%) adequate/diagnostic and 6 (14%) inadequate/non-diagnostic cases. The diagnostic group included 17 (46%) malignant and 20 (54%) benign cases. Of the malignant category (17 cases), 11 (65%) were diagnosed as positive for adenocarcinoma, 4 (23%) as neuroendocrine tumor, 1 (6%) as solid pseudo-papillary neoplasm, and 1 (6%) as non-Hodgkin’s lymphoma. The benign category (20 cases) included 5 (25%) cysts/pseudo-cysts, 8 (40%) non-specific pancreatitis, 4 (20%) granulomatous/tuberculous pancreatitis, 1 (5%) benign neoplasm, and 2 (10%) benign not otherwise specified, both were proven to be false-negative cases. The sensitivity, specificity and accuracy rate for the diagnosis of cancers were 74, 100, and 86%, respectively. No false-positive results were reported. All malignant cases showed characteristic cytomorphologic features that were sufficient for their diagnosis. Conclusion: EUS-FNA in adequate samples is an efficient and accurate modality in the diagnosis of pancreatic lesions. Applying immunohistochemical studies on cell-block preparation can facilitate the final, definitive, and specific diagnosis of some difficult pancreatic neoplasms.

Keywords:
Cytology, Fine needle aspiration, endoscopic ultrasound-guided, Immunohistochemistry, Pancreas
1.
Protiva P, Sahai AV, Agarwal A: Endoscopic ultrasonography in the diagnosis and staging of pancreatic neoplasms. Int J Gastrointest Cancer 2001;30:33–45.
2.
Will U, Mueller A, Topalidis T, Meyer F: Value of endoscopic ultrasonography-guided fine needle aspiration (FNA) in the diagnosis of neoplastic tumor(-like) pancreatic lesions in daily clinical practice. Ultraschall Med 2010;31:169–174.
3.
Levy MJ, Wiersema MJ: Pancreatic neoplasms. Gastrointest Endosc Clin N Am 2005;15:117–142.
4.
Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA: Endoscopic ultrasound-guided fine-needle aspiration: a cytopathologist’s perspective. Am J Clin Pathol 2003;120:351–367.
5.
Afify AM, Al-Khafaji BM, Kim B: Endoscopic ultrasound-guided fine needle aspiration of the pancreas: diagnostic utility and accuracy. Acta Cytol 2003;47:341–348.
6.
Mitsuhashi T, Ghafari S, Chang CY, Gu M: Endoscopic ultrasound-guided fine needle aspiration of the pancreas: cytomorphological evaluation with emphasis on adequacy assessment, diagnostic criteria and contamination from gastrointestinal tract. Cytopathology 2006;17:34–41.
7.
Sears D, Erickson RA, Sayage-Rabie L, Escobar MC: TGF-b and p53 staining in CT-guided and endoscopic ultrasound fine-needle aspirates of pancreatic adenocarcinoma. Dig Dis Sci 2004;49:828–832.
8.
Cohen MB, Egerter DP, Holly EA: Pancreatic adenocarcinoma: regression analysis to identify improved cytologic criteria. Diagn Cytopathol 1991;7:341–345.
9.
LeBlanc JK, Ciaccia D, Al-Assi MT: Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc 2004;59:475–481.
10.
Klapman JB, Logron R, Dye CE: Clinical impact of on-site cytopasthology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 2003;98:1289–1294.
11.
Shin HJC, Lahoti S, Sneige N: Endoscopic ultrasound-guided fine-needle aspiration in 179 cases: the M.D. Anderson Cancer Center experience. Cancer 2002;96:174–180.
12.
Giovannini M, Seitz JF, Monges F, Perier H, Rabbia I: Fine needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients. Endoscopy 1995;27:171–177.
13.
Lin F, Staerkel GA: Cytologic criteria for well-differentiated adenocarcinoma of the Pancreas in fine needle aspiration biopsy specimens. Cancer 2003;99:44–50.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.