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Background: The diagnostic yield of EUS-guided FNA (EUS-FNA) of solid pancreatic masses is a potential benchmark for EUS-FNA quality, because the majority of EUS-FNA of solid pancreatic masses should be diagnostic for malignancy. Objectives: To determine the cytologic diagnostic rate of malignancy in EUS-FNA of solid pancreatic masses and to determine if variability exists among endoscopists and centers. Design: Multicenter retrospective study. Patients: EUS centers provided cytology reports for all EUS-FNAs of solid, noncystic, ≥10-mm-diameter, solid pancreatic masses during a 1-year period. Main Outcome Measurement: Cytology diagnostic of pancreatic malignancy. Results: A total of 1075 patients underwent EUS-FNA at 21 centers (81% academic) with 41 endoscopists. The median number of EUS-FNA of solid pancreatic masses performed during the year per center was 46 (range, 4-177) and per endoscopist was 19 (range, 1-97). The mean mass dimensions were 32 × 27 mm, with 73% located in the head. The mean number of passes was 3.5. Of the centers, 90% used immediate cytologic evaluation. The overall diagnostic rate of malignancy was 71%, 95% confidence interval 0.69%-0.74%, with 5% suspicious for malignancy, 6% atypical cells, and 18% negative for malignancy. The median diagnostic rate per center was 78% (range, 39%-93%; 1st quartile, 61%) and per endoscopist was 75% (range, 0%-100%; 1st quartile, 52%). Limitations: Retrospective study, participation bias, and varying chronic pancreatitis prevalence. Conclusions: (1) EUS-FNA cytology was diagnostic of malignancy in 71% of solid pancreatic masses and (2) endoscopists with a final cytologic diagnosis rate of malignancy for EUS-FNA of solid masses that was less than 52% were in the lowest quartile and should evaluate reasons for their low yield. [Copyright &y& Elsevier]

Tumors of the extrahepatic ducts are relatively rare and consist mostly of adenocarcinomas. Carcinoid tumors of the bile duct are exceedingly rare (1-4). Only 26 cases of carcinoid tumors of the bile duct are reported in the literature (5); 3 of these occurred in childhood or adolescence (1,6,7). Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy is an effective method for tissue diagnosis of periintestinal lymphadenopathy, especially in the posterior mediastinum and the celiac axis area (8). We report this case to illustrate the role of EUS-FNA in diagnosing recurrent metastatic carcinoid Klatskin's tumor to a celiac lymph node in a teenager. [ABSTRACT FROM AUTHOR]

This study assessed the ability of spectral analysis of endoscopic ultrasound (EUS) RF signals acquired in humans in vivo to distinguish between (1) benign and malignant intraabdominal and mediastinal lymph nodes and (2) pancreatic cancer, chronic pancreatitis, and normal pancreas. Mean midband fit, slope, intercept, and correlation coefficient from a linear regression of the calibrated RF power spectra were computed over regions of interest defined by the endoscopist. Linear discriminant analysis was then performed to develop a classification of the resulting spectral parameters. For lymph nodes, classification based on the midband fit and intercept provided 67% sensitivity, 82% specificity, and 73% accuracy for malignant vs. benign nodes. For pancreas, classification based on midband fit and correlation coefficient provided 95% sensitivity, 93% specificity, and 93% accuracy for diseased vs. normal pancreas and 85% sensitivity, 71% specificity, and 85% accuracy for pancreatic cancer vs. chronic pancreatitis. These promising results suggest that mean spectral parameters can provide a non-invasive method to quantitatively characterize pancreatic cancer and lymph malignancy in vivo.