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Accuracy and other quality indicators of solid pancreatic mass endoscopic ultrasound-guided fine needle aspiration and biopsy in two academic endoscopy centers

Journal Volume 84 - 2021
Issue Fasc.3 - Original articles
Author(s) M. Figueiredo 1, M. Arvanitakis 1, A. Zaarour 2, E. Toussaint 1, J. Devière 1, J.L. Van Laethem 1, M. Gomez-Galdon 3, L. Verset 3 4, P. Demetter 3 4, P. Eisendrath 1 2
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Full Article
PAGES 451-455
(1) Department of Gastroenterology, Hepatopancreatology and Digestive oncology, Erasme Hospital, Université Libre de Bruxelles, Belgium
(2) Department of Gastroenterology and Hepatology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Belgium
(3) Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
(4) Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium

Background and aims: Endoscopic ultrasound fine-needle aspiration/biopsy (EUS-FNA/FNB) is highly accurate, but discrepancies between cytological and surgical diagnoses are still observed. We aimed to determine its accuracy and monitor quality indicators in our facilities.

Patients and methods: We performed a retrospective review of all cases of pancreatic solid lesions evaluated by EUS-FNA/FNB, between July 2015 and June 2018, in two centers. Cytological and surgical findings were categorized into five groups: benign, malignant, suspect of malignancy, undetermined and insufficient for diagnosis. Final diagnosis was based on surgical diagnosis and, in patients who did not undergo surgery, on clinical outcome after 6 months follow-up.

Results: Altogether, 142 patients were included. FNA was the preferred tissue acquisition method (88%), with a predilection for the FNA 22G needle (57%). Cytology was insufficient for diagnosis in 2 cases, therefore a full diagnostic sample was available in 98.6% of the patients (>90%, ESGE target). Fifty-five (38.7%) patients underwent surgery. In term of cancer diagnosis, comparison with final surgical pathology (n=55) revealed 89% true positives, 5.5% true negatives, 3.6% false positives and 1.8% false negatives. When combining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was 92.3% (74.9-99.1), positive predictive value was 98.2% (93.6- 99.5), negative predictive value was 88.9% (72.3-96.1) and accuracy was 96.4% (91.9-98.8). Post-procedural acute pancreatitis was reported in 2 patients (1.4%).

Conclusions: These results reveal a performance for diagnostic tissue sampling well above the ESGE proposed target standard. Also, the uncommon high specificity illustrates the determining role of the pathologist’s final interpretation and diagnosis.

Keywords: endoscopic ultrasound-guided sampling, fine-needle aspiration/biopsy, pancreas, accuracy, quality monitoring.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 34599570