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%).