Endoscopic Ultrasonography-Guided Fine-Needle Aspiration Biopsy Of Suspected Pancreatic Cancer (EUSFNA) The most often limitations of the cytologic smears

Background: Pancreatic mass lesions discovered in subhepatal region of abdominal cavity are most often caused by pancreatic adenocarcinoma. This malignant disease is leading to death in 80% patients and it is also the fourth cancer cause of death. For diagnoses of this illness is useful endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS FNA), which is especially helpful for localization of small lesions of pancreas undetected by computer tomography.

Material: We performed between years of 2007 and 2011 in our laboratory 501 cases of pancreatic lesions. Material was taken out with method of EUS-FNA. Most bioptic cases just contained pancreatic adenocarcinoma, which was observed in 56% samples. In addition, we obtained also 22 speciments of cell atypias (4%) and we didn´t find any malignant cells in 45 samples (9%). The cytologic smear was interpreted as „positiv for malignancy“ when at least three of following criteria were present in decreasing order of importace: 1. loss of the honeycomb pattern of ductal epithelial celles in a group, 2. anisonucleosis of cells in a group, 3. nuclear contour iregularity, 4. nuclear enlargement, 5. parachromatin clearing, 6. presence of prominent nucleoli in the absence of intraepithelial inflammatory cells.

Results: Most often the limitations in interpretation of diagnosis are the thick overlapping groups of cells in mucous and bloody smears, complete cytolysis of cell population which is caused by central necroses of the tumor masses or contusion of the diagnostic elements. In situation of complete cytolysis we recommend to clinician to take a sample from the periphery of examinated locus.

Conclusion: Quick and correct assessment of diagnosis using the method of EUS-FNA provides to us in short time important informations about the character of observing lesion. The sensitivity of this method is 64-96%, specificity is almost 100%.