Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions

• Published in: Gastrointestinal endoscopy Vol. 76; no. 1; pp. 76 - 83
• Main Authors: Ranney, Nathaniel, MD, Phadnis, Milind, PhD, Trevino, Jessica, MD, Ramesh, Jayapal, MD, Wilcox, C. Mel, MD, Varadarajulu, Shyam, MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.07.2012; Elsevier
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Fine-Needle; Chi-Square Distribution; Digestive system. Abdomen; Endoscopy; Endosonography; False Negative Reactions; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Jaundice, Obstructive - etiology; Jaundice, Obstructive - therapy; Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatitis, Chronic - diagnosis; Retrospective Studies; Statistics, Nonparametric; Stents; Ultrasonography, Interventional; self-expandable metal stent; IQR; interquartile range; SEMS; Sonography; Biliary tract; Fine needle; Endoscopic route; Endoscopic ultrasonography; Echography; Instrumentation therapy; Lesion; Pancreas; Aspiration punction; Stent
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.02.049

Background Few studies have evaluated the impact of biliary stents on EUS-guided FNA. Aim To compare diagnostic yield of EUS-FNA in patients with or without biliary stents. Design Retrospective study. Setting Tertiary referral center. Patients Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years. Main Outcome Measures The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis. Results Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001). Limitations Retrospective study. Conclusions The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.