Repeated Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) Improved Diagnostic Yield of Inconclusive Initial Cytology for Suspected Pancreatic Cancer and Unknown Intra-Abdominal Lymphadenopathy
Varayu Prachayakul MD*, Tassanee Sriprayoon MD*, Pitulak Asawakul MD*, Supot Pongprasobchai MD*, Nonthalee Pausawasdi MD*, Udom Kachintorn MD*
Affiliation : * Siriraj GI Endoscopy Center, Department of Internal Medicine, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
Background : Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is considered as an effective technique to
obtain cytology specimens for definite diagnosis of the patients who were suspected of having pancreatic cancer and unknown
intra-abdominal lymphadenopathy. The value of repeated EUS-FNA in these patients who had inconclusive first EUS-FNA
cytology is not well established.
Objective : To determine the yield of repeated EUS-FNA in obtaining a definite diagnosis in patients with clinically suspect for
pancreatic cancer and unknown intra-abdominal lymphadenopathy including the reasons for which initial EUS-FNA failed.
Material and Method: The authors retrospectively reviewed the EUS database of Siriraj endoscopy center, from January
2007 to May 2011, to identify all patients who underwent repeated EUS-FNA for high index suspicion of pancreatic cancer and
unknown intra-abdominal lymphadenopathy. The inconclusive results of the first EUS-FNA, the factors associated with non-
diagnosed versus diagnosed cytology results were compared.
Results : A total of 478 EUS- FNA were performed in our institution. Fifteen patients (6M, 9F), mean age of 57 + 11.8 years
(30-72 years) had repeated EUS-FNA done for the evaluation of possible malignant diseases. Eight of these patients presented
with pancreatic masses and the other seven patients had unknown intra-abdominal lymphadenopathy. The second EUS-FNA
diagnosed and was truly benign in 4 patients. Repeated EUS-FNA facilitated determination of the true status of the disease in
13 of 15 patients which 9 of whom were malignancy. Sensitivity, specificity, positive predictive value, negative predictive value
and accuracy of repeated EUS-FNA for both inconclusive pancreatic masses and unknown intra-abdominal lymphadenopathy
were 90%, 100%, 100%, 80% and 92.8% respectively.
Conclusion : Repeated EUS-FNA for inconclusive initial cytology of patients with suspected pancreatic cancer and unknown
intra-abdominal lymphadenopathy provided a very high yield for definite tissue diagnosis and should be recommended.
Keywords : EUS-FNA, Pancreatic mass, Lymphadenopathy, Repeated, Fine needle aspiration, EUS guided, Pancreatic cancer
