Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

Abstract EN

Background.

There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions.

To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required.

The utility of repeat EUS-FNA is not well established.

Methods.

A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology.

The wait times to the second procedure and to decisions regarding therapy were calculated.

Results.

Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions.

Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%).

Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA.

The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%).

The median time interval between first and second EUS-FNA was 31 (7–175) days.

Conclusions.

A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care.