Lower yield of endoscopic ultrasound-guided fine-needle aspiration in patients with pancreatic head mass with a biliary stent.
Dig Dis Sci
; 60(2): 543-9, 2015 Feb.
Article
em En
| MEDLINE
| ID: mdl-25245115
ABSTRACT
BACKGROUND:
In jaundiced patients with suspected pancreatic cancer, endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent is frequently performed prior to histologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).AIMS:
To compare the accuracy of jaundiced patients undergoing EUS-FNA for a pancreatic mass with or without a biliary stent.METHODS:
Consecutive patients with a pancreatic mass and jaundice who underwent EUS-FNA between 4/2005 and 4/2013 were identified. Final diagnosis was based on histologic or radiologic evaluation with >6-month follow-up if the index EUS-FNA was negative for malignancy. Primary endpoint was histologic accuracy of EUS-FNA.RESULTS:
Mean age of the 180 patients was 65 ± 12 years; 83 (46 %) had ERCP prior to EUS-FNA and 75 (42 %) received a biliary stent. Onsite cytopathologist was present for 81 (45 %) procedures. Final diagnosis revealed malignancy in 172 (96 %) patients, with adenocarcinoma in 159 (88 %). Patients with biliary stents had lower accuracy of EUS-FNA for malignancy than those without a biliary stent 77 % (95 % CI 67-85 %) versus 89 % (95 % CI 81-93 %). On multivariate analysis, having a biliary stent (OR = 0.37, 95 % CI 0.15-0.90), onsite cytopathologist (OR = 9.24, 95 % CI 2.64-32.37), and receiving a core biopsy (OR = 2.60, 95 % CI 1.07-6.29) were associated with accuracy of EUS-FNA.CONCLUSIONS:
Presence of a biliary stent was associated with a significant decrease in the accuracy of EUS-FNA for histologic diagnosis of pancreatic cancer, while accuracy was increased when a cytopathologist was onsite. EUS-FNA should be performed prior to ERCP in jaundiced patients with suspected pancreatic cancer.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Pancreáticas
/
Adenocarcinoma
/
Stents
/
Colangiopancreatografia Retrógrada Endoscópica
/
Icterícia Obstrutiva
/
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Dig Dis Sci
Ano de publicação:
2015
Tipo de documento:
Article