Lower Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Pancreatic Head Mass with a Biliary Stent

Abstract

Background: In jaundiced patients with suspected pancreatic cancer, endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent is frequently performed prior to histologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Aims: To compare the accuracy of jaundiced patients undergoing EUS-FNA for a pancreatic mass with or without a biliary stent. Methods: Consecutive patients with a pancreatic mass and jaundice who underwent EUS-FNA between 4/2005 and 4/2013 were identified. Final diagnosis was based on histologic or radiologic evaluation with >6-month follow-up if the index EUS-FNA was negative for malignancy. Primary endpoint was histologic accuracy of EUS-FNA. Results: Mean age of the 180 patients was 65 ± 12 years; 83 (46 %) had ERCP prior to EUS-FNA and 75 (42 %) received a biliary stent. Onsite cytopathologist was present for 81 (45 %) procedures. Final diagnosis revealed malignancy in 172 (96 %) patients, with adenocarcinoma in 159 (88 %). Patients with biliary stents had lower accuracy of EUS-FNA for malignancy than those without a biliary stent: 77 % (95 % CI 67–85 %) versus 89 % (95 % CI 81–93 %). On multivariate analysis, having a biliary stent (OR = 0.37, 95 % CI 0.15–0.90), onsite cytopathologist (OR = 9.24, 95 % CI 2.64–32.37), and receiving a core biopsy (OR = 2.60, 95 % CI 1.07–6.29) were associated with accuracy of EUS-FNA. Conclusions: Presence of a biliary stent was associated with a significant decrease in the accuracy of EUS-FNA for histologic diagnosis of pancreatic cancer, while accuracy was increased when a cytopathologist was onsite. EUS-FNA should be performed prior to ERCP in jaundiced patients with suspected pancreatic cancer.