Fine-needle biopsy of the pancreas using real-time ultrasonography

Reliability of Ultrasound-Guided Fine-Needle Biopsy of Pancreatic Masses

Fine-needle aspiration biopsy (FNB) was performed with ultrasound guidance in 79 patients in whom sonography had revealed a mass suggesting pancreatic malignancy. The final diagnosis (surgery, autopsy and clinical course) in 69 of these 79 patients was a malignancy closely related to the pancreas while in the remaining 10 patients benign disease was confirmed. A correct diagnosis of malignancy was attained by FNB in 59 of the 69 patients with a malignant tumour while in 10 it failed to confirm the diagnosis. FNB yielded a true negative result in 10 patients with benign disease. The accuracy of sonographically guided FNB in the present investigation was 87 per cent. Ultrasound-guided fine-needle biopsy is considered the method of choice for further evaluation of pancreatic masses.

Misinterpretation of normal cellular elements in fine-needle aspiration biopsy specimens: observations from the College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytopathology

CONTEXT

The College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytopathology is a popular educational program for nongynecologic cytology, with 1018 participating laboratories by the end of 2000. Data generated from this program allow tracking pathologist performance in a wide variety of laboratory practices.

OBJECTIVE

To review performance of participating pathologists in making patient diagnoses with fine-needle aspiration biopsy specimens, with particular interest in the false neoplastic diagnoses (both benign and malignant neoplasms) that were submitted for benign aspirates containing only normal cellular components.

DESIGN

We reviewed the diagnoses made from 1998 through 2000 by participating pathologists through the use of glass slides containing benign fine-needle aspiration biopsy specimens of the liver, kidney, pancreas, and salivary gland that contained only normal cellular components.

RESULTS

The false neoplastic rate for kidney (60%) was the highest, followed by liver (37%), pancreas (10%), and salivary gland (6%). These rates are much higher than what has previously been reported in the literature.

CONCLUSIONS

This study illustrates that normal cellular elements are a significant pitfall for overinterpretation of fine-needle aspiration biopsy specimens.

Role of fine needle aspiration cytology and endoscopic biopsy in the preoperative assessment of pancreatic and peripancreatic malignancies

Sixty-seven of 207 patients with pancreatic and peripancreatic malignancies underwent preoperative fine needle aspiration cytology (FNA), and 24 patients underwent intraluminal endoscopic biopsies. All patients had confirmation of the diagnosis of malignancy either at operation, autopsy, or by clinical follow-up. FNA of liver metastases was positive for malignancy in 12 of 12 patients. FNA of the pancreas was performed on 44 patients with pancreatic adenocarcinoma and 11 patients with other pancreatic or peripancreatic malignancies. The diagnosis of cancer was established by FNA in 32 of 44 (72.4%) patients with pancreatic adenocarcinoma and 1 of 11 patients (9.1%) with other pancreatic or peripancreatic malignancies. In the patients with pancreatic adenocarcinoma, 17 of 18 patients (94.4%) who had no operative intervention, 12 of 18 (66.7%) patients who had palliative bypass procedures, and 3 of 8 (37.5%) patients resected had positive FNA. Eighteen of 24 patients (75%) who underwent intraluminal endoscopic biopsies, and 11 of 15 (73.3%) with ampullary carcinoma were positive. We believe that FNA is of limited value in the diagnosis of small resectable tumors of the pancreas as it identified cancer in only 3 of 8 patients in whom it was employed. False negative FNA may delay the diagnosis and treatment of pancreatic malignancies. Patients in whom there is a high index of suspicion of pancreatic or peripancreatic malignancy based on clinical presentation, CT scan, or ERCP assessment do not require preoperative, histologic proof of malignancy prior to pancreaticoduodenectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative fine needle aspiration cytology of pancreatic lesions

The aim of the present study was to demonstrate the practicality of intraoperative fine needle aspiration (FNA) cytology of pancreatic lesions in 43 patients. The indication for performing this procedure was to determine the nature of pancreatic masses. Conclusive cytologic diagnoses were reached in 41 patients who represent the present study. On the basis of histologic findings in 30 cases (73.2%) and on clinical findings in 11 cases (26.8%), a final diagnosis of malignant pancreatic disease (MPD) was established in 31 and of benign pancreatic disease (BPD) in 10 patients. Among the 31 cases with MPD, the cytologic diagnosis was correct in 30 patients and falsely negative in one patient. Among 10 patients with BPD, all the cytologic finding were reported as benign. The sensitivity and specificity and positive and negative predictive values for cytologic findings were 96.8%, 100%, 100%, and 90.9%, respectively. The diagnostic accuracy of FNA cytology was 97.6%. No complications followed the procedure. We conclude that intraoperative FNA cytology of pancreatic lesions is a simple, safe, highly sensitive, and specific tool in differentiating benign from malignant pancreatic lesions. This procedure should be carried out in any patient with pancreatic mass incidentally found at laparotomy or in a patient undergoing surgery because of suspected nonmetastasizing MPD in whom repeated imaging guided FNA failed to demonstrate malignancy.

Percutaneous biopsy of pancreatic lesions

Percutaneous biopsy provides an effective means of tissue diagnosis in pancreatic lesions. Accuracy rates are ranging between 72 and 100%, with a sensitivity for carcinomas between 69 and 90% and a constantly high specificity of 100% in most series of the literature. The rate of major complications is low, with an incidence of about 0.05%.