Advertisement

Effect of Pancreatic Mass Size on Clinical Outcomes of Endoscopic Ultrasound-Guided Fine-Needle Aspiration

  • Ryo Sugiura
  • Masaki KuwataniEmail author
  • Koji Hirata
  • Itsuki Sano
  • Shin Kato
  • Kazumichi Kawakubo
  • Naoya Sakamoto
Original Article
  • 41 Downloads

Abstract

Background

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has high diagnostic accuracy for pancreatic diseases. However, the effect of mass size on diagnostic accuracy has yet to be determined, especially for small pancreatic lesions. We aimed to determine the effect of pancreatic mass size on the diagnostic yield of EUS-FNA.

Methods

We searched the database in Hokkaido University Hospital between May 2008 and December 2016 and identified solid pancreatic lesions examined by EUS-FNA. All lesions were stratified into five groups based on mass sizes: groups A (< 10 mm), B (10–20 mm), C (20–30 mm), D (30–40 mm) and E (≥ 40 mm). The sensitivity, specificity, diagnostic accuracy and adverse event rate were retrospectively evaluated.

Results

We analyzed a total of 788 solid pancreatic lesions in 761 patients. The patients included 440 males (57.8%) with a mean age of 65.7 years. The sensitivities in groups A (n = 36), B (n = 223), C (n = 304), D (n = 147) and E (n = 78) were 89.3%, 95.0%, 97.4%, 98.5% and 98.7%, respectively, and they significantly increased as the mass size increased (P < 0.01, chi-squared test for trend). The diagnostic accuracies were 91.7%, 96.4%, 97.7%, 98.6% and 98.7%, respectively, and they also significantly increased as the mass size increased (P = 0.03). Multivariate analysis showed that pancreatic mass size was associated with diagnostic accuracy. The adverse event rates were not significantly different among the five groups.

Conclusions

The sensitivities and diagnostic accuracies of EUS-FNA for solid pancreatic lesions are higher for lesions ≥ 10 mm in size, and they are strongly correlated with mass size.

Keywords

Endoscopic ultrasonography Endoscopic ultrasonography fine-needle aspiration Pancreatic tumor 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Vilmann P, Jacobsen GK, Henriksen FW, Hancke S. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992;38:172–173.CrossRefGoogle Scholar
  2. 2.
    Itoi T, Sofuni A, Itokawa F, Irisawa A, Khor CJ, Rerknimitr R. Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions. Dig Endosc. 2011;23:17–21.CrossRefGoogle Scholar
  3. 3.
    Haba S, Yamao K, Bhatia V, et al. Diagnostic ability and factors affecting accuracy of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions: Japanese large single center experience. J Gastroenterol. 2013;48:973–981.CrossRefGoogle Scholar
  4. 4.
    Hebert-Magee S, Bae S, Varadarajulu S, et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology. 2013;24:159–171.CrossRefGoogle Scholar
  5. 5.
    Touchefeu Y, Le Rhun M, Coron E, et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy. Aliment Pharmacol Ther. 2009;30:1070–1077.CrossRefGoogle Scholar
  6. 6.
    Madhoun MF, Wani SB, Rastogi A, et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis. Endoscopy. 2013;45:86–92.CrossRefGoogle Scholar
  7. 7.
    Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc. 2005;62:728–736.CrossRefGoogle Scholar
  8. 8.
    Hwang CY, Lee SS, Song TJ, et al. Endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of pancreatic and peripancreatic lesions: a single center experience in Korea. Gut Liver. 2009;3:116–121.CrossRefGoogle Scholar
  9. 9.
    Siddiqui AA, Brown LJ, Hong SK, et al. Relationship of pancreatic mass size and diagnostic yield of endoscopic ultrasound-guided fine needle aspiration. Dig Dis Sci. 2011;56:3370–3375.  https://doi.org/10.1007/s10620-011-1782-z.CrossRefPubMedGoogle Scholar
  10. 10.
    Uehara H, Ikezawa K, Kawada N, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic malignancy in relation to the size of lesions. J Gastroenterol Hepatol. 2011;26:1256–1261.CrossRefGoogle Scholar
  11. 11.
    Ramesh J, Kim H, Reddy K, Eltoum IE. Performance characteristic of endoscopic ultrasound-guided fine needle aspiration is unaffected by pancreatic mass size. Endosc Int Open. 2016;4:E434–438.CrossRefGoogle Scholar
  12. 12.
    Varadarajulu S, Fockens P, Hawes RH. Best practices in endoscopic ultrasound-guided fine-needle aspiration. Clin Gastroenterol Hepatol. 2012;10:697–703.CrossRefGoogle Scholar
  13. 13.
    Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. 4th ed. Lyon: International Agency for Research on Cancer; 2010.Google Scholar
  14. 14.
    Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40:352–358.CrossRefGoogle Scholar
  15. 15.
    Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.CrossRefGoogle Scholar
  16. 16.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–458.CrossRefGoogle Scholar
  17. 17.
    Egawa S, Toma H, Ohigashi H, et al. Japan pancreatic cancer registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41:985–992.CrossRefGoogle Scholar
  18. 18.
    Kulke MH, Benson AB 3rd, Bergsland E, et al. Neuroendocrine tumors. J Natl Compr Canc Netw. 2012;10:724–764.CrossRefGoogle Scholar
  19. 19.
    Dewitt J, Devereaux BM, Lehman GA, Sherman S, Imperiale TF. Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol. 2006;4:717–725. (quiz 664).CrossRefGoogle Scholar
  20. 20.
    Agarwal B, Abu-Hamda E, Molke KL, Correa AM, Ho L. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol. 2004;99:844–850.CrossRefGoogle Scholar
  21. 21.
    Sakamoto H, Kitano M, Komaki T, et al. Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol. 2009;24:384–390.CrossRefGoogle Scholar
  22. 22.
    Turner BG, Cizginer S, Agarwal D, Yang J, Pitman MB, Brugge WR. Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc. 2010;71:91–98.CrossRefGoogle Scholar
  23. 23.
    Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol. 2011;106:1705–1710.CrossRefGoogle Scholar
  24. 24.
    Matynia AP, Schmidt RL, Barraza G, Layfield LJ, Siddiqui AA, Adler DG. Impact of rapid on-site evaluation on the adequacy of endoscopic-ultrasound guided fine-needle aspiration of solid pancreatic lesions: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2014;29:697–705.CrossRefGoogle Scholar
  25. 25.
    O’Toole D, Palazzo L, Arotcarena R, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001;53:470–474.CrossRefGoogle Scholar
  26. 26.
    Wang KX, Ben QW, Jin ZD, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc. 2011;73:283–290.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ryo Sugiura
    • 1
  • Masaki Kuwatani
    • 2
    Email author
  • Koji Hirata
    • 1
  • Itsuki Sano
    • 1
  • Shin Kato
    • 1
  • Kazumichi Kawakubo
    • 1
  • Naoya Sakamoto
    • 1
  1. 1.Department of Gastroenterology and HepatologyHokkaido University Faculty of Medicine and Graduate School of MedicineSapporoJapan
  2. 2.Division of EndoscopyHokkaido University HospitalSapporoJapan

Personalised recommendations