Objective: The rate of pancreatic lesions has increased in recent decades due to the widespread use of advanced imaging techniques. Nowadays, a significant proportion of cases are incidentally discovered in asymptomatic patients and cytology is an important tool for the diagnosis and multidisciplinary management of these cases. Study Design: In this study we retrospectively review the experience with pancreatic fine-needle aspiration cytology in the last 17 years at a single large tertiary hospital in Madrid, Spain. Results: Our results indicate that more than 60% of pancreatic malignant lesions are cytologically confirmed before surgery and 30% of the patients are asymptomatic. Despite this, we have noted that the total number of malignant lesions surgically resected in our hospital has basically remained unchanged over the years, because incidental diagnosis is not always synonymous with resectability and a substantial number of patients are already metastatic at the time of diagnosis. Our series also shows an increase in the number of neuroendocrine tumors, which now represent almost 20% of all cytological diagnoses at our hospital. The sensitivity in our series is 70% and the false negative rate remains 30%, despite sample quality control by experienced cytologists and standardized technical conditions. Fibrosis and necrosis are the 2 features of the primary tumor that significantly and negatively influence the accuracy of cytologic diagnosis. Conclusion: We herein report our experience with cytologic diagnosis of pancreatic lesions in a single tertiary hospital. Our results confirm that cytology is a safe, reliable, and important tool for pancreatic lesion diagnosis and management.

1.
Frampas E, David A, Regenet N, Touchefeu Y, Meyer J, Morla O: Pancreatic carcinoma: key-points from diagnosis to treatment. Diagn Interv Imaging 2016; 97: 1207–1223.
2.
Illic M, Illic I: Epidemiology of pancreatic cancer. World J Gastroenterol 2016; 22: 694–9705.
3.
Coté GA, Xu H, Easler JJ, Imler TD, Teal E, Sherman S, Korc M: Informative patterns of health-care utilization prior to the diagnosis of pancreatic ductal adenocarcinoma. Am J Epidemiol 2017; 186: 944–951.
4.
Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW: Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: large-scale, single-center cohort study. Medicine (Baltimore) 2016; 95:e5535.
5.
Sharma C, Eltawil KM, Renfrew PD, Walsh MJ, Molinari M: Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990–2010. World J Gastroenterol 2011; 17: 867–897.
6.
Siegel RL, Miller KD, Jemal A: Cancer Statistics, 2016. CA Cancer J Clin 2016; 66: 7–30.
7.
Cohen S, Kagen AC: Preoperative evaluation of a pancreas mass: diagnostic options. Surg Clin North Am 2018; 98: 13–23.
8.
Gupta P, Rajwanshi A, Nijhawan R, Srinivasan R, Gupta N, Saikia UN, et al: Fine needle aspiration in retroperitoneal lesions. APMIS 2017; 125: 16–23.
9.
Gupta RK: Value of image guided fine-needle aspiration cytology in the diagnosis of pancreatic malignancies. Diagn Cytopathol 1995; 13: 120–123.
10.
Bhatia P, Srinivasan R, Rajwanshi A, Nijhawan R, Khandelwal N, Wig J, et al: 5-year review and reappraisal of ultrasound-guided percutaneous transabdominal fine needle aspiration of pancreatic lesions. Acta Cytol 2008; 52: 523–529.
11.
Qureshi A, Hassan U, Loya A, Akhter N, Najam-ud-Din, Yusuf A: Diagnostic utility of endoscopic ultrasound guided aspiration cytology in evaluation of pancreatic masses. J Coll Physicians Surg Pak 2013; 23: 484–486.
12.
O’Connell AM, Keeling F, Given M, Logan M, Lee MJ: Fine-needle trucut biopsy versus fine-needle aspiration cytology with ultrasound guidance in the abdomen. J Med Imaging Radiat Oncol 2008; 52: 231–236.
13.
Schneider AR, Nerlich A, Topalidis T, Schepp W: Specialized clinical cytology may improve the results of EUS (endoscopic ultrasound)-guided fine-needle aspiration (FNA) from pancreatic tumors. Endosc Int Open 2015; 3:E134–E137.
14.
Frozanpor F, Albiin N, Linder S, Segersvärd R, Lundell L, Arnelo U: Impact of pancreatic gland volume on fistula formation after pancreatic tail resection. JOP 2010; 11: 439–443.
15.
Lozano MD, Panizo A, Sola IJ, Pardo-Mindán FJ: FNAC guided by computed tomography in the diagnosis of primary pancreatic adenosquamous carcinoma: a report of three cases. Acta Cytol 1998; 42: 1451–1454.
16.
Lin CY, Ou MC, Liu YS, Chuang MT, Shan YS, Tsai HM, et al: A CT-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels. Saudi J Gastroenterol 2017; 23: 341–347.
17.
Hawes RH, Zaidi S: Endoscopic ultrasonography of the pancreas. Gastrointest Endosc Clin N Am 1995; 5: 61–80.
18.
Noh DH, Choi K, Gu S, Cho J, Jang KT, Woo YS, et al: Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial. Scand J Gastroenterol 2018; 53: 94–99.
19.
Mosteiro L, Corominas-Cishek A, Muñiz G, Pérez A, Barturen A, Casado I, et al: Ultrasound-guided endoscopic fine needle aspiration cytology in pancreatic lesions: a series of 43 cases with histologic correlation from a single institution. Anal Quant Cytopathol Histpathol 2014; 36: 9–14.
20.
Fritscher-Ravens A, Brand L, Knöfel WT, Bobrowski C, Topalidis T, Thonke F, et al: Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 2002; 97: 2768–2775.
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.