Abstracts

T1602 Utility of EUS-FNA in the Diagnosis of Pancreatic Neuroendocrine Tumors: Correlation with Histopathology in 76 Patients Shireen A. Pais, Kathleen Mcgreevy, Julia K. Leblanc, Stuart Sherman, Lee Mchenry, John M. Dewitt
Introduction: Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that are classied as functional (F-NET) or nonfunctional (NF-NET) depending on the presence or absence of excess hormone production. Endoscopic ultrasound (EUS)guided ne needle aspiration (EUS-FNA) is often used to diagnose NETs but there are limited data on its sensitivity for this indication. Aim: To determine the sensitivity of EUS-FNA for the diagnosis of a NET. Methods: We retrospectively identied all patients from 7/95 to 11/06 who underwent EUS for suspected or subsequently conrmed pancreatic NET. Patients with excluded with: 1) extrapancreatic tumors alone; 2) EUS-FNA of a pancreatic tumor was not performed. The diagnosis of a NETwas conrmed by: 1) EUS-FNA with or without conrmatory immunochemistry (ICC) with synaptophysin and chromogranin of? 1 pancreatic mass or metastatic site; or 2) an alternative biopsy method and/or surgical resection of the pancreas or other metastatic site. Results: 92 patients (56 male; median age: 57 yrs, range: 23-83 yrs) with 34 (37%) F-NET and 58 (63%) NF-NETs were identied. By EUS, the tumors were located in the pancreatic head, body, tail or were multifocal in 38 (41%), 27 (29%), 19 (21%) and 8 (9%), respectively. Of these 92, 76 (83%) underwent EUS-FNA of a pancreatic mass, 36 (47%) of whom also had a EUSFNA of an alternative (nonpancreatic) site including the liver (n Z 15; 16%), another lesion in the pancreas (n Z 7; 8%), or lymph node (n Z 9; 10%; peripancreatic in 5, celiac in 3 and mediastinal in 1). Immunohistochemistry was performed in 51/76 (67%) EUS-FNA specimens and the results were: ICC-positive (n Z 44), ICC-negative (n Z 5), not interpretable (n Z 1) or inadequate for interpretation (n Z 1). Surgery was performed in 41 (54%): distal pancreatectomy (n Z 16), Whipple procedure (n Z 10), enucleation (n Z 10) and subtotal (n Z 2) or total pancreatectomy (n Z 1). The remaining two who underwent surgery had an exploratory laparotomy only. 66 patients had a conrmed diagnosis of NET and the sensitivity of EUS-FNA is shown in Table 1. The results of the false-negative EUSFNA biopsies of the pancreas (n Z 12) were interpreted as: normal in 2, suspicious in 2, nondiagnostic in 5, adenocarcinoma in 2, and a solid pseudopapillary tumor in 1. Conclusion: EUS-FNA is a sensitive method for the diagnosis of pancreatic NETs but yield is lower in tumors smaller than 15 mm in diameter. Sensitivity of EUS-FNA for the diagnosis of NETs ALL (n Z 76) Sensitivity (confidence intervals%) 84% (74-90) F-NET (n Z 28) 78% (60-90) NF-NET (n Z 48) 89% (75-95) Lesions less than or equal to 15 mm (n Z 21) 62% (41-79)

(n Z 12) and enlarged periportal nodes with metastasis (n Z 1). Eight patients had benign stricture which included 3 with PSC, 2 with inammatory pseudo-tumors and 3 patients without specic etiologic cause. There were 5 false negative diagnoses- 2 patients had cancer detected by surgery and 3 patients developed metastases. The accuracy of EUS-FNA for diagnosis of cancer was 76.2%, with 61.5% sensitivity, 100% specicity, 61.5% NPV and 100% PPV. Summary and conclusions: EUS-FNA can be a useful tool in obtaining a tissue diagnosis of malignancy in patients with obstructive jaundice and PBS, when brush cytology of the stricture is not denitively diagnostic of malignancy. The low negative predictive value of EUS FNA indicates that a negative biopsy can not reliably exclude malignancy. Our study supports a recently published similar study. Both studies are limited by small cohort size since proximal strictures are relatively uncommon.

T1604 Value of Endosonography to Predict Symptomatic Stenosis of the Pancreatic Sphincter Nittly Chahal-Sekhon, Viktor E. Eysselein, David Chung
Aims: To evaluate the symptomatic response of Pancreatic Sphincterotomy in patients with a dilated pancreatic duct as determined by Endosonography. We hypothesized that a dilated pancreatic duct near the papilla predicts pancreatic sphincter stenosis in patients with pancreatic type pain. Methods: Retrospective study in patients with possible pancreatic-type pain underwent follow-up from 1 to 6 months after pancreatic sphincterotomy. Having a dilated pancreatic duct (Oor Z 4 mm) near the papilla was assessed by endosonography. Follow-up data were retrospectively obtained using a structured questionnaire; the main parameter for evaluating treatment success was a signicant reduction in pain following Endosonography. Pain severity before and after pancreatic sphincterotomy performed by Endoscopic Retrograde Cholangiopancreato-graphy (ERCP) was determined using a scale from 0 to 10, 10 being the most severe. Results: Pancreatic ducts (PD) that were measured less than or equal to 2 mm were a designated normal control group without symptomatic pain. Of 22 patients with painful pancreatic-type pain, 14 were male & 8 were female with an average of a 1 to 6 month follow-up. The pain degree decreased signicantly (p ! 0.0001) from 8.2 0.3 to 3.0 0.3 (means SEM)in the patients with dilated pancreatic duct after pancreatic sphincterotomy (see Table below). 27% of the patients had a normal diagnostic study on CT and/or MRCP but on Endosonography the pancreatic duct was actually dilated using a cutoff of 4 mm. Conclusions: Our preliminary data suggest that a dilated pancreatic duct on Endosonography in patients with pancreatic-type pain predicts stenosis of the pancreatic sphincter. Pancreatic sphincterotomy in those patients leads to signicant pain relief. Diagnostic imaging methods such as C.T./MRCP revealed a normal pancreatic duct in 27% of patients but had a dilated pancreatic duct on Endosonography. C.T./MRCP are therefore inferior to endosonography in predicting symptomatic pancreatic sphincter stenosis. Thus, Endosonography appears a promising and more accurate method for diagnosing symptomatic pancreatic sphincter stenosis. Pain scale (mean SEM) Group Dilated panc. duct )))p ! 0.0001 Before 8.2 0.3 After 3.0))) 0.3 % Change 63

T1603 Endoscopic Ultrasound Guided Fine Needle Aspiration Biopsy for Diagnostic Evaluation of Proximal Biliary Strictures Banke Agarwal, Jennifer L. Labundy, Naveen B. Krishna, Brian T. Collins
Background: Determining the etiology of proximal biliary strictures (PBS) remains a challenge. Even though endoscopic ultrasound guided ne needle aspiration (EUS-FNA) has potential and is often used in evaluation of PBS, its role in the diagnostic evaluation of PBS is still not clearly established due to a lack of sufcient data. Patients and Methods: We retropectively studied the performance characteristics of EUS-FNA in patients with obstructive jaundice and PBS in our institution from March 2002 to March 2006. Patients with stricture conned above the hepatic bifurcation were excluded. Patients with history of liver transplantation were also not included due to markedly different probability of cancer in these patients. EUS examination was performed using a radial echoendoscope followed by a linear echoechoendoscope in all patients. EUS-FNA was performed using 22G or 25G needles. FNAs were stained by Diff-Quik and Papanicolaou method with immediate assessment by an attending cytopathologist. EUS-FNA was classied as positive only if a denitive cytologic diagnosis of malignancy was made. The nal patient outcome was based on surgical pathology or clinical follow-up of at least 12 months. Results: Twenty-one patients qualied for inclusion (13 male, 8 female), with mean age of 61.6 16.3 years (range 23 to 87). The strictures ranged in length from 10-70 mm. All patients had jaundice at the time of presentation for ERCP and had a biliary stent in place at the time of EUS-FNA. CT revealed a hilar mass lesion in 9 patients. In 13 patients, a nal diagnosis of cancer was made- cholangiocarcinoma

AB304 GASTROINTESTINAL ENDOSCOPY Volume 65, No. 5 : 2007

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