Su1391 Value of Cytology Combined With Histology by EUS-FNA in the Solid Pancreatic Mass and Intra-Abdominal Lymphadenopathy

Su1391 Value of Cytology Combined With Histology by EUS-FNA in the Solid Pancreatic Mass and Intra-Abdominal Lymphadenopathy Tae Hyeon Kim, Young Woo Sohn, Jun Young Lee, Keum Ha Choi, Hyo Jeong Oh Internal Medicine, Wonkwang University Hospital, Iksan, Republic of Korea; Internal Medicine, Wonkwang Unversity Hospital, Sanbon, Republic of Korea; Pathology, Wonkwang University hospital, Iksan, Republic of Korea Background and Aim: Endoscopic ultrasound guided fine-needle aspiration (EUSFNA) is a safe and accurate technique for diagnosing pancreatic tumor. Small core biopsies can be obtained with conventional EUS-FNA. Although most studies have concentrated on the cytology of specimen, few data existed on the histologic assessment. The aim of this study were to determine whether core biopsies by conventional EUS-FNA can increase the accuracy of EUS-guided sampling when combined with cytology when no on-site cytopathologist is present. Method: In the 66 consecutive patients(68 lesions) undergoing EUS-FNA of solid pancreatic masses and intra-abdominal lymphadenopathy between May/ 2009 and July/2010 at a tertiary university hospital without on-site pathologist, adequate tissue coil from the needle were harvested for histology; residual tissue was examed for cytology. The adequacy of sampling, the sensitivities, specificities and overall accuracies of cytology or histology alone and combined cytology-histology were determined. Result: 66 patients ( 38 male and 28 female, mean age 64.9 10.9) with 68 lesions were enrolled. Adequate samples were obtained by EUS-FNA cytology, histology, and combined cytology-histology in 93.8%, 69.2%, 95.4% of patients, respectively. From the pancreas (n 44), adequate samples for histology were obtained by FNA in 78.5%, compared with 52.2% from non-pancreatic cases (n 24), respectively (p 0.01). The significant factors affecting the rate of adequate sample for histology were mass size ( 2cm), malignant lesion, and pancreatic lesion(p 0.05). Overall sensitivity and accuracy of EUS-FNA was 81.9% and 84.6% for cytology alone, 60.0% and 63.1% for histology alone, and 88.2% and 89.2% for combined cytology-histology, respectively (p 0.01, compared to cytology alone). Conclusion: This study shows that combined cytology and histology analysis in diagnosing pancreatic mass and intra-abdominal lymphadenopathy may increase the sensitivity and accuracy of conventional EUS-FNA.