Diagnosis of Pancreatic Cancer with EUS-

FNA:

Factors That Influence Adequate Sampling

Ali Lankarani, MD

3rd year GI fellowAllegheny General Hospital / Drexel University

Pittsburgh

Manish K. Dhawan, MD

Disclaimer:Not an endosonographer

Pancreatic Cancer

• Forth-leading cause of cancer death in USA

• In 2010 and 35,240 will die from this cancer

• 5-year survival rate = 5.5%

• EUS alone is not specific

• EUS-FNA is the modality of choice for obtaining tissue

• Tissue diagnosis is mandatory before chemotherapy

• Onsite cytopathologist, if available, can confirm the adequacy of sample

• More than one needle pass is usually needed

Identifying the factors that may influence the number of FNA passes:

• Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer (n=188)

• Analyze the effect of the following variations:– FNA needle size– Location of the mass – Size of the tumor – Endosonographer’s experience

Endosonographer’s experience

0

0.5

1

1.5

2

2.5

3

3.5

25 50 75 100 125 150 175

Number of patients

Aver

age

FNA

pass

es

Mass size

<10 mm (n=5)

11-20 mm (n=24)

21-30 mm (n=62)

31-40 mm (n=55)

41-50 mm (n=13)

51-70 mm (n=8)

Ave # of Passes

2.4 3.1 2.4 2.4 3.0 2.5

Size of pancreatic mass

0

0.5

1

1.5

2

2.5

3

3.5Nu

mber

of FN

A pa

ss

# pass head (n=34) # pass body (n=143) # pass tail (n=8)

Tumor Location

Location of the tumor