Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

Table 1 Sensitivity and specificity of various diagnostic approaches to a pancreatic mass lesion

Modality	Sensitivity	Specificity
CA 19-9	70%-92%	68%-92%
CT	77%-97%	56%-89%
Transabdominal ultrasound	89%	99%
Percutaneous FNA	62%-90%	98%-100%
ERCP	49%-66%	96%
EUS-FNA	75%-98%	71%-100%
EUS-FNB	85%-95%	86%-100%

EUS-FNA: Endoscopic ultrasound-guided fine needle aspiration; EUS-FNB: Endoscopic ultrasound-guided fine needle biopsy; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Techniques to increase diagnostic yield and decrease complications during endoscopic ultrasound-guided fine needle aspiration of a pancreatic mass

Pre-procedural considerations	General 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 Considerations	Take 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 Processing	Use on-site cytopathology or perform 7 needle passes

EUS-FNA: Endoscopic ultrasound-guided fine needle aspiration.