Review
Copyright ©The Author(s) 2016.
World J Gastroenterol. Oct 21, 2016; 22(39): 8658-8669
Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8658
Table 1 Sensitivity and specificity of various diagnostic approaches to a pancreatic mass lesion
ModalitySensitivitySpecificity
CA 19-970%-92%68%-92%
CT77%-97%56%-89%
Transabdominal ultrasound89%99%
Percutaneous FNA62%-90%98%-100%
ERCP49%-66%96%
EUS-FNA75%-98%71%-100%
EUS-FNB85%-95%86%-100%
Table 2 Techniques to increase diagnostic yield and decrease complications during endoscopic ultrasound-guided fine needle aspiration of a pancreatic mass
Pre-procedural considerationsGeneral anesthesia may increase yield
Goal platelet count greater than 50000 and INR less than 1.5 to reduce risk of bleeding
Hold antiplatelet and antithrombotic agents except aspirin or NSAIDS
Procedural ConsiderationsTake caution when duodenal diverticulum is present to reduce risk of perforation
Use Doppler to identify vasculature prior to needle advancement to avoid bleeding
Use smaller (22 or 25) gauge needles for transduodenal FNA of the pancreatic head and uncinate
If core histology samples needed, use 19G (in body or tail) or core biopsy needles
Use suction
Use the “fanning technique” during FNA
Traverse the least amount of normal pancreatic tissue to reduce pancreatitis
Specimen ProcessingUse on-site cytopathology or perform 7 needle passes