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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 628-640
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.628
Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis
Hiroyuki Matsubayashi, Toru Matsui, Yohei Yabuuchi, Kenichiro Imai, Masaki Tanaka, Naomi Kakushima, Keiko Sasaki, Hiroyuki Ono
Hiroyuki Matsubayashi, Toru Matsui, Yohei Yabuuchi, Kenichiro Imai, Masaki Tanaka, Naomi Kakushima, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Keiko Sasaki, Division of Pathology, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Author contributions: All authors contributed on this work.
Conflict-of-interest statement: All authors disclose no conflict of interest related to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroyuki Matsubayashi, MD, PhD, Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntogun, Shizuoka 411-8777, Japan. h.matsubayashi@scchr.jp
Telephone: +81-55-9895222 Fax: +81-55-9895692
Received: May 27, 2015
Peer-review started: May 28, 2015
First decision: September 11, 2015
Revised: September 20, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 14, 2016
Processing time: 224 Days and 14.5 Hours
Abstract

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.

Keywords: Endoscopic ultrasonography-guided fine-needle aspiration; Diagnosis; Pancreaticobiliary; Pancreatic; Cancer

Core tip: Since the first attempts in 1990th, the instruments and methodology associated with endoscopic ultrasonography-guided fine needle aspiration have been largely improved for greater safety and efficacy of the procedure and accuracy of diagnosis. Choices of suitable needle and puncture method (fanning, suction, stylet, number of the passes) are critical for the better diagnostic yields of the pancreaticobiliary lesions as well as improving endosonographic skills.