Clin Endosc.  2014 Sep;47(5):420-424. 10.5946/ce.2014.47.5.420.

Neoplasia in Chronic Pancreatitis: How to Maximize the Yield of Endoscopic Ultrasound-Guided Fine Needle Aspiration

• Bang JY
• Varadarajulu S

• KMID: 2165373
• DOI: http://doi.org/10.5946/ce.2014.47.5.420

Abstract

When performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), identifying neoplasia in the setting of chronic pancreatitis can be technically challenging. The morphology of an ill-defined mass on sonography, presence of calcifications or intervening collaterals, reverberation from a biliary stent, low yield of tissue procurement, and interpretative errors in cytopathology can result in both false-negative and false-positive results. Although these challenges cannot be completely eliminated, elastography or contrast-enhanced imaging can aid in differentiating an inflammatory mass from a neoplasm. Also, performing more passes of FNA, procuring core biopsy material, performing rapid onsite evaluation, conducting ancillary pathology studies, and even repeating the procedure on a different day can aid in improving the diagnostic performance of EUS-FNA. This review provides a concise update and offers practical tips to improving the diagnostic yield of EUS-FNA when sampling solid pancreatic mass lesions in the setting of chronic pancreatitis.

Keyword

Endosonography; Biopsy; Biopsy, fine-needle; Pancreatitis, chronic; Pancreatic neoplasms

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Elasticity Imaging Techniques
Endoscopic Ultrasound-Guided Fine Needle Aspiration*
Endosonography
Pancreatic Neoplasms
Pancreatitis, Chronic*
Pathology
Stents
Tissue and Organ Procurement

Figure

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  Fig. 1 (A) A hypoechoic mass simulating a neoplasm is observed on linear endosonography. (B) However, a careful examination reveals the mass to be a conglomeration of lobules secondary to chronic pancreatitis.

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  Fig. 2 Hyperechoic shadowing by a pancreatic duct stone obscures an underlying pancreatic adenocarcinoma.

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  Fig. 3 The presence of collateral vasculature makes tissue acquisition more challenging in chronic pancreatitis.

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