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Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 122-129

EUS-guided tissue acquisition in chronic pancreatitis: Differential diagnosis between pancreatic cancer and pseudotumoral masses using EUS-FNA or core biopsy

1 Gastroenterology and Digestive Endoscopy Unit, Cremona Hospital, Cremona, Italy
2 Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, “Federico II” of Naples, Naples, Italy
3 Gastroenterology and Digestive Endoscopy Unit, Hospital “A. Maresca”, Torre del Greco, Naples, Italy
4 Gastroenterology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
5 Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy
6 Pathology Unit, Cremona Hospital, Cremona, Italy
7 Division of Surgery, Cremona Hospital, Cremona, Italy
8 Gastroenterology and Digestive Endoscopy Unit, A.O. Salvini, Garbagnate Milanese, Milan, Italy
9 Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

Correspondence Address:
Dr. Roberto Grassia
Gastroenterology and Digestive Endoscopy Unit, ASST Ospedale di Cremona, Cremona
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_75_19

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Background and Objective: EUS-FNA sensitivity for malignancy in parenchymal masses of patients with concurrent chronic pancreatitis (CP) has been reported to be unsatisfactory. The aim of the present study was to directly compare the diagnostic accuracy of EUS-FNA and EUS-fine-needle biopsy (FNB) in differentiating between inflammatory masses and malignancies in the setting of CP. Methods: We performed a retrospective analysis of prospective, multicentric databases of all patients with pancreatic masses and clinico-radiological-endosonographic features of CP who underwent EUS-FNA or FNB. Results: Among 1124 patients with CP, 210 patients (60% males, mean age: 62.7 years) with CP and pancreatic masses met the inclusion criteria and were enrolled. In the FNA group (110 patients), a correct diagnosis was obtained in all but 18 cases (diagnostic accuracy 83.6%, sensitivity 69.5%, specificity 100%, positive predictive value [PPV] 100%, and negative predictive value [NPV] 73.9%); by contrast, among 100 patients undergoing FNB, a correct diagnosis was obtained in all but seven cases (diagnostic accuracy 93%, sensitivity 86.8%, specificity 100%, PPV 100%, and NPV 87%) (P = 0.03, 0.03, 1, 1, and 0.07, respectively). At binary logistic regression, focal pancreatitis (odds of event occurrence [OR]: 4.9; P < 0.001), higher Ca19-9 (OR: 2.3;P= 0.02), and FNB (OR: 2.5; P < 0.01) were the only independent factors associated with a correct diagnosis. Conclusion: EUS-FNB is effective in the differential diagnosis between pseudotumoral masses and solid neoplasms in CP, showing higher diagnostic accuracy and sensitivity than EUS-FNA. EUS-FNB should be considered the preferred diagnostic technique for diagnosing cancer in the setting of CP.

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