Relevance of Ultrasound–Guided Fine Needle Aspiration in Solid and Cystic Pancreatic Lesions

Dr. Ram Nawal Rao; Dr. Paramita Paul; Dr. Pallavi Prasad; Dr. Varnika Rai

Volume : VI, Issue : XI, November - 2017

Relevance of Ultrasound–Guided Fine Needle Aspiration in Solid and Cystic Pancreatic Lesions

Dr. Ram Nawal Rao, Dr. Paramita Paul, Dr. Pallavi Prasad, Dr. Varnika Rai

Abstract :

Background: Ultrasound guided – FNA in adequate samples is an efficient, applicable and accurate modality in the diagnosis of pancreatic solid and cystic lesions in developing countries where Endoscopic FNA is lacking or not standardized.

Aims and Objectives : A 7–year retrospective study of FNA samples of 240 pancreatic lesions was performed to evaluate the diagnostic utility and safety of ultrasound–guided fine needle aspiration (US–FNA) cytology in solid and cystic pancreatic lesions.

Materials and Methods: The entire cases were diagnosed with US–FNA using 22 gauge spinal needles via a percutaneous transabdominal approach alongwith highly diagnostic accuracy leading to early management and better survival of the patients.The aspirated material was quickly smeared into glass slides, air dried, wet fixed in 95% ethyl alcohol for subsequent Papanicolaou staining.

Results The study included 240 cases (142 men and 98 women ).Five cases yielded insufficient material for diagnosis. The aspirates were classified as benign (n=70) and malignant lesions (n=165). Of the 70 benign aspirates, the cytological diagnosis was acute/chronic inflammation in 16 patients including granulomatous inflammation in 12 patients and microfilariasis in one. Miscellaneous lesions included serous cystadenoma in 5, mucinous cystic neoplasms in 4, pancreatic pseudocysts in 6 and benign aspirates (not otherwise specified) which composed of some anisomorphic benign ductal and acinar cells in 20 patients. Of the 165 malignant aspirates, the cytological diagnosis was adenocarcinoma in 116 cases, malignant lymphoma in 11, neuroendocrine/carcinoid tumor in 7, solid pseudopapillary tumors (SPTs) in 6, mucinous adenocarcinoma in 5, adenosquamous carcinoma in 5, mesenchymal neoplasia in 2, and acinar cell carcinoma, squamous cell carcinoma, and undifferentiated carcinoma in one patient each, and metastatic adenocarcinoma in 10 patient. Cytohistologic correlation was available in 65 (28 benign and 37malignant lesions ) and in the benign category, six false negative diagnoses were rendered on FNA. 4 lesions were diagnosed as adenocarcinoma and 2 as neuroendocrine carcinoma on histology. Conclusions: US–FNA is still relevant in both solid and cystic pancreatic lesions. Further, to obtain high diagnostic accuracy, a multimodal approach with good clinical, radiologic and cytologic correlation is recommended.