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Ali Lankarani, MD
3rd year GI fellowAllegheny General Hospital / Drexel University
Pittsburgh
Manish K. Dhawan, MD
Disclaimer:Not an endosonographer
Pancreatic Cancer
• Forth-leading cause of cancer death in USA
• In 2010 and 35,240 will die from this cancer
• 5-year survival rate = 5.5%
• EUS alone is not specific
• EUS-FNA is the modality of choice for obtaining tissue
• Tissue diagnosis is mandatory before chemotherapy
• Onsite cytopathologist, if available, can confirm the adequacy of sample
• More than one needle pass is usually needed
Identifying the factors that may influence the number of FNA passes:
• Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer (n=188)
• Analyze the effect of the following variations:– FNA needle size– Location of the mass – Size of the tumor – Endosonographer’s experience
Endosonographer’s experience
0
0.5
1
1.5
2
2.5
3
3.5
25 50 75 100 125 150 175
Number of patients
Aver
age
FNA
pass
es
Mass size
<10 mm (n=5)
11-20 mm (n=24)
21-30 mm (n=62)
31-40 mm (n=55)
41-50 mm (n=13)
51-70 mm (n=8)
Ave # of Passes
2.4 3.1 2.4 2.4 3.0 2.5
Size of pancreatic mass
0
0.5
1
1.5
2
2.5
3
3.5Nu
mber
of FN
A pa
ss
# pass head (n=34) # pass body (n=143) # pass tail (n=8)
Tumor Location
Location of the tumor