Retrospective examination of the factors associated with the diagnostic accuracy of EUS-FNA for pancreatic solid masses

Background: Pancreatic cancer is becoming a growing cause of cancer-related mortality as we approach the end of the third decade of the 2000s. One in eight patients is deemed resectable at the time of diagnosis and early detection of these patients is the most important predictor of five-year survival. The endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) procedure, which has become the most common method for the fastest and safest histopathological diagnosis, the gold standard in the diagnosis of the disease, cannot always be performed within the framework of rapid on-site cytopathologist evaluation. Therefore, our aim was to examine the relationship between demographic, clinical and technical factors and the diagnostic accuracy of the procedure in this study. Materials and Methods: Between June 2020 and September 2023, 95 patients, aged between 18-90 years who underwent EUS-FNA for pancreatic solid lesions in the Endoscopy Unit of Düzce University Hospital were included in the study. The demographic information of the patients including age and gender, clinical characteristics including the location and diameter of the mass, technical details including the diameter of the needle, sampling technique and number of needle passes. Cytopathological diagnoses and final clinical diagnoses were recorded. Binary logistic regression analysis was used to calculate the effect of the parameters on the accuracy of the cytological diagnosis. Results: The groups were homogeneous in terms of age and gender distribution. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA for pancreatic solid masses were 77%, 100%, 100%, 100%, 28.6%, and 79%, respectively. The age and gender of the patients did not make a significant difference in the diagnosis of malignancy by EUS-FNA. Similarly, no significant difference was found in terms of location of the mass and diagnostic accuracy for masses of 50 mm or less in diameter; however, diagnostic accuracy was significantly higher for masses of 51 mm or more. Needle diameter, sampling technique and number of passes did not significantly affect the overall diagnostic performance. Conclusion: In patients undergoing EUS-FNA for pancreatic solid lesions, demographic factors such as age or gender did not have a significant effect on the diagnosis of malignancy. Similarly, the localization of the mass did not significantly affect the diagnostic accuracy, and the diagnostic performance of EUS-FNA performed on masses larger than 5 cm was significantly higher, while needle diameter, sampling technique or number of passes did not significantly affect the diagnostic accuracy. We hope that our study will guide future studies. Keywords: pancreatic neoplasms, endoscopic ultrasonography, fine needle aspiration