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Endoscopic Ultrasound Guided Fine-Needle Aspiration of Solid Pancreatic Lesions: Predictive Factors to Obtain an Adequate Diagnostic Sample

Federico Salom, Kenneth Ernest, William Piedra

Introduction Endoscopic ultrasound fine-needle aspiration has a crucial role in tissue acquisition of solid pancreatic lesions. Conflicting data exists regarding the impact of rapid on-site cytopathology evaluation and the type of needle used to improve the diagnostic yield.

Aims and Methods A retrospective observational study from patients that had a pancreatic endoscopic ultrasound fine-needle aspiration, from a tertiary referral center was performed. Factors that correlated with an adequate tissue acquisition for cytological diagnosis after performing pancreatic endoscopic ultrasound fine-needle aspiration were evaluated. Patient’s demographics, lesions size and location, type of needle used, rapid on-site cytopathology evaluation and final pathological diagnosis were obtained. The population was divided in two groups, according to the acquisition of a diagnostic sample. The baseline characteristics were compared with t-test and Fisher’s exact test, for continuous and categorical variables, respectively. Uni and multivariate logistic regression models were elaborated in order to establish the correlation between our covariates and the odds for viable tissue acquisition.

Results We collected data from 126 patients, 55.5% were women. The mean age was 61.59±12.18 years (range 21-85). The pancreatic lesion average size was 37.03±13.28 mm (range 8-70 mm). Most lesions were located in the head of the pancreas (73.8%). Regular fine-needle aspiration needles were used in 83.3% of the procedures. Most of them were 22-gauge needles (86.5%). Rapid on-site cytopathology evaluation was available in 32.5% of the procedures. A suitable diagnostic sample was obtained in 108 (85.7%) of the patients. After controlling other covariates, only the presence of rapid on-site cytopathology evaluation was significant (p=0.021, OR: 11.89) for diagnostic tissue acquisition.

Conclusion Endoscopic ultrasound fine-needle aspiration is the standard of care for tissue acquisition of solid pancreatic lesions. Whenever available, rapid on-site cytopathology evaluation should be used, to increase the diagnostic yield of this procedure.