Small and Potentially Resectable Focal Pancreatic Lesions Noted on CT/MRI Scans in Nonjaundiced Patients: Likelihood of Neoplasia and Utility of EUS

Management of small and potentially resectable mass lesions encountered on CT/MRI scans in patients without obstructive jaundice (ObJ) is rather empirical since there is scant data on likelihood of neoplasm to formulate treatment strategies. We evaluated (1) the prevalence of neoplasm and (2) performance characteristics of EUS-FNA for diagnosing neoplasm in above-mentioned subset of patients. This is a retrospective analysis of 232 patients (without ObJ) with a focal pancreatic lesion, <= 25 mm and potentially resectable on CT/MRI who underwent EUS-FNA from 2002 to 2009. Seventy-five patients (32.3%, 95% CI 26.6, 38.6) were finally diagnosed to have a neoplasm. Four of 92 (4.3%) lesions <= 15 mm, 13 of 57(22.8%) lesions 16-20 mm, and 35 of 83 (42.1%) lesions 21-25 mm had an adenocarcinoma. Larger lesion size, older patient age, and h/o recent weight loss significantly increased the likelihood of adenocarcinoma. EUS-FNA had 98.2% overall accuracy and 98.1% NPV with no significant differences based on lesion size. In nonjaundiced patient with a potentially resectable pancreatic lesion <= 25 mm in size noted on CT/MRI scanning, EUS-FNA can provide useful adjunctive information to optimize the use of surgery and can potentially obviate the need for wait and watch approach with repeat imaging in their clinical management.