Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions

Gastrointest Endosc. 2012 Jul;76(1):76-83. doi: 10.1016/j.gie.2012.02.049.

Abstract

Background: Few studies have evaluated the impact of biliary stents on EUS-guided FNA.

Aim: To compare diagnostic yield of EUS-FNA in patients with or without biliary stents.

Design: Retrospective study.

Setting: Tertiary referral center.

Patients: Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years.

Main outcome measures: The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis.

Results: Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001).

Limitations: Retrospective study.

Conclusions: The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.

MeSH terms

  • Adenocarcinoma / complications
  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Fine-Needle*
  • Chi-Square Distribution
  • Endosonography
  • False Negative Reactions
  • Female
  • Humans
  • Jaundice, Obstructive / etiology
  • Jaundice, Obstructive / therapy
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology*
  • Pancreatitis, Chronic / diagnosis
  • Retrospective Studies
  • Statistics, Nonparametric
  • Stents*
  • Ultrasonography, Interventional