PWE-065 Four years' experience of the use of endoscopic ultrasound for the diagnosis of pancreatic malignancy. (June 2019)

• Record Type: Journal Article
• Authors: Dong, Chaonan; Devaraj, Mamatha; Oliver, Andrew; Rasteli, Frankie; Majumdar, Debasis; Dean, Jeremy; Mitra, Vikramjit
• Is Part Of: Gut. Volume 68(2019)Supplement 2
• Page Start: A157
• Page End: A157
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.296
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: EUS guided tissue acquisition is an extensively used investigation to confirm the histopathological diagnosis in PB lesions. The Joint Advisory Group (JAG) suggests an adequacy rate of more than 75% for EUS-Fine Needle Aspiration cytology (FNAC) [1] . The aim of this study was to determine the diagnostic performance, adequacy of tissue acquisition and safety of EUS-FNA in PB lesions in a non-HPB centre in the UK. Methods: We carried out a retrospective audit of all patients (identified from endoscopy and pathology database) who underwent EUS-FNA between 1st January 2015 and 31st December 2018. Data collected include patient demographics, cross-sectional imaging, cytopathological diagnoses (Panc 1 to 5 based on European cytopathology classification of PB terminology [2] ; neuroendocrine tumours were included in Panc 5), treatment modality, complications and 30 day procedure related mortality. Final diagnoses were confirmed from EUS FNAC, surgical resection specimen or cross-sectional imaging discussed in a MDT setting (if histology negative). Results: A total of 152 patients [mean age 66.9 years, 53.9% females] underwent 161 PB EUS-FNAC procedures. 135 patients had a final diagnosis of cancer. 144 (89.4%) samples were deemed adequate for analysis. Sensitivity, specificity, overall accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 87.7%, 100%, 88.9%, 100%, and 46.7% respectively [with Panc3 included as false negative in patients with cancer as final diagnosis]. These figures would improve to 94.2%, 100%, 94.8%, 100%, and 66.7% respectively if Panc3 is excluded from false negative category in cancer group. There was no procedure related complications or mortality. Conclusion: This study confirms that EUS-FNA of PB lesions can be highly effective and safely carried out in a non-HPB centre. Overall adequacy of tissue acquisition is in compliance with JAG guidelines. Our diagnostic yield is in in keeping with the published literature [2] . Our NPV is relatively low because the purpose of EUS-FNA was to confirm suspected cancer on cross-sectional imaging. Reference: 1. JAG (Joint Advisory Group) on Gastrointestinal Endoscopy the. Guidance - JAG Summary guide to quality and safety indicators Dumonceau JM, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017;49:695–714