EUS-guided fine needle aspiration with and without trucut biopsy of pancreatic masses

Context: Endoscopic ultrasound-guided trucut biopsy (EUS TCB) has a lower yield than fine needle aspiration (FNA) in pancreatic masses but the additional use of TCB to FNA may improve the diagnostic accuracy over FNA alone. Objective: To compare the yield of EUS FNA alone or combined with EUS TCB for diagnosis of pancreatic masses. Design: Single center retrospective case control study conducted at academic tertiary center. Study conducted between March 2004 and April 2007. Participants: A total of 126 consecutive patients referred for EUS guided biopsy of pancreatic mass; three patients excluded from analysis, final cohort comprised 123 patients (108 malignant and 15 benign). EUS FNA was performed in 72 patients and EUS FNA+TCB was performed in 51 patients. Main outcome measures: The diagnostic performance of EUS FNA versus EUS FNA+TCB was compared. Results: The, sensitivity, specificity and frequency of cases correctly identified for malignancy of FNA alone were 87.1% (54/62), 100% (10/10) and 88.8% (64/72), while for the combination of FNA+TCB they were: 95.7% (44/46), 100% (5/5) and 96.0% (49/51), respectively (P=0.184, 1.000, and 0.193 FNA versus FNA+TCB). No major complication occurred in either group. Conclusion: FNA+TCB can be safely performed in selected lesions but sensitivity is not statistically improved over FNA alone (95.7% versus 87.1%).