Factors affecting the accuracy of endoscopic ultrasound-guided fine needle aspiration for the diagnosis of small (≤20 mm) pancreatic lesions.
AIMS: The main objective was to explore the diagnostic value of Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for small solid pancreatic lesions (≤20 mm) and factors affecting the accuracy in these patients. METHODS: 92 patients with small pancreatic lesions who underwent EUS-FNA at the Nanjing Drum Tower Hospital from November 2009 to January 2019 were retrospectively analyzed. Univariate and multivariate were used to analyze the factors affecting the accuracy of EUS-FNA for these lesions. RESULTS: Among the 92 patients, 56 (60.9%) cases were malignant and 36 (39.1%) were benign. The cytology and the histology were determined adequate in 92(100 %) and 76(86.0%) cases. The sensitivity, specificity and accuracy of EUS-FNA for the diagnosis of small pancreatic solid lesions were 69.20%, 100% and 82.6%, respectively. When considering the impact of the presence of a tissue core on the diagnosis, the sensitivity, specificity, and accuracy of EUS-FNA with histology versus those without histology (cytology alone) were 77.3% versus 50%; 100% versus 100%; 76.2% versus 40%, respectively. Multivariate analysis demonstrated that smaller tumor size (OR = 4.200, 95% CI: 1.21-14.53, p = 0.023) and lack of histological diagnosis (OR = 4.593, 95% CI: 1.03-20.47, p = 0.046) significantly reduce puncture accuracy. CONCLUSIONS: Our results suggest that EUS-FNA is effective and safe for the diagnosis of small pancreatic lesions. Tumor size and presence of macroscopic visible tissue core is related to the accuracy of EUS-FNA.