The value of concurrent endoscopic ultrasound-guided fine needle aspirates and needle core biopsies in the diagnosis of pancreatic neoplasms.

Background: Endoscopic ultrasound (EUS) fine needle aspiration (FNA) is highly sensitive and specific in the detection and diagnosis of pancreatic neoplasms. EUS-guided needle core biopsy has been used alone or as an adjunct to maximize diagnostic yield. This study compared the use of FNA versus needle core biopsy in the diagnosis of pancreatic neoplasms.

Methods: From January 1, 2018 through December 21, 2020, the Cytopathology Laboratory processed 374 FNAs from solid pancreatic masses of which 332 (89%) had concurrent pancreatic biopsies and form the basis of this study.

Results: Of the 332 FNAs, 173 (52%) were positive/suspicious for pancreatic adenocarcinoma, 33 (10%) were positive for a neoplasm, 20 (6%) were atypical 19 (6%) were negative and 87 (26%) were non-diagnostic. Biopsies were concordant in 248 (75%) cases and discordant in 84 (25%) cases. Of the 84 discordant cases, 29 (35%) had neoplastic cells on FNA of which 14 were atypical, 11 were negative and 4 were nondiagnostic on core biopsy. Of the 18 (21%) FNAs with atypical cells, 8 showed adenocarcinoma on core biopsy. Thirty-seven nondiagnostic FNAs showed adenocarcinoma on 25 (70%) core biopsies. If nondiagnostic FNAs were included, FNA sensitivity was 89% and specificity; 100%, and both were 100%, if the nondiagnostic cases were excluded. The needle core biopsy sensitivity was 91% and specificity; 100%.

Conclusion: Both FNAs and core biopsies show high sensitivity and specificity in the detection of pancreatic neoplasms. However, combining the techniques enhances cellular yields and provides material for ancillary tests.