Review
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World J Gastroenterol. Jul 28, 2014; 20(28): 9451-9457
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9451
Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses
Julio Iglesias-Garcia, Jose Lariño-Noia, Ihab Abdulkader, J Enrique Domínguez-Muñoz
Julio Iglesias-Garcia, Jose Lariño-Noia, J Enrique Domínguez-Muñoz, Department of Gastroenterology and Hepatology, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
Ihab Abdulkader, Department of Pathology, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
Author contributions: Iglesias-Garcia J made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content; Lariño-Noia J and Abdulkader I drafted the article and revised it critically for important intellectual content; Domínguez-Muñoz JE gave final approval of the version to be published.
Correspondence to: Julio Iglesias-Garcia, MD, PhD, Department of Gastroenterology and Hepatology, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain. julio.iglesias.garcia@sergas.es
Telephone: +34-981-951364 Fax: +34-981-955100
Received: October 31, 2013
Revised: April 24, 2014
Accepted: May 19, 2014
Published online: July 28, 2014
Abstract

Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, differential diagnosis remains a clinical challenge. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting. EUS-guided FNA and FNB, by obtaining cytological and/or histological samples, are able to diagnose pancreatic lesions with high sensitivity and specificity. In this context, several methodological features, trying to increase the diagnostic yield of EUS-guided FNA and FNB, have been evaluated. In this review, we focus on the role of rapid on-site evaluation (ROSE). From data reported in the literature, ROSE may increase diagnostic yield of EUS-FNA specimens by 10%-30%, and thus, diagnostic accuracy. However, we should point out that many recent studies have reported adequacy rates of > 90% without ROSE, indicating that, perhaps, at high-volume centers, ROSE may not be indispensable to achieve excellent results. The use of ROSE can be considered important during the learning curve of EUS-FNA, and also in hospital with diagnostic accuracy rates < 90%.

Keywords: Endoscopic-ultrasound-guided fine-needle aspiration, Rapid on-site evaluation, Solid pancreatic tumors, Diagnostic accuracy

Core tip: Endoscopic ultrasound (EUS) has become a crucial tool for the evaluation of solid pancreatic masses. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting, and can diagnose pancreatic lesions with high sensitivity and specificity. The use of rapid on-site evaluation can increase adequacy rates and diagnostic yield of EUS-guided FNA or FNB by 10%-30%.