• Varayu Prachayakul, Tassanee Sriprayoon, Pitulak Asawakul, Supot Pongprasobchai, Nonthalee Pausawasdi, and Udom Kachintorn.
• Siriraj GI Endoscopy Center, Department of Internal Medicine, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand. kaiyjr@gmail.com
• J Med Assoc Thai. 2012 Feb 1; 95 Suppl 2: S68-74.

BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is considered as an effective technique to obtain cytology specimens for definite diagnosis of the patients who were suspected of having pancreatic cancer and unknown intra-abdominal lymphadenopathy. The value of repeated EUS-FNA in these patients who had inconclusive first EUS-FNA cytology is not well established.ObjectiveTo determine the yield of repeated EUS-FNA in obtaining a definite diagnosis in patients with clinically suspect for pancreatic cancer and unknown intra-abdominal lymphadenopathy including the reasons for which initial EUS-FNA failed.Material And MethodThe authors retrospectively reviewed the EUS database of Siriraj endoscopy center from January 2007 to May 2011, to identify all patients who underwent repeated EUS-FNA for high index suspicion of pancreatic cancer and unknown intra-abdominal lymphadenopathy. The inconclusive results of the first EUS-FNA, the factors associated with non-diagnosed versus diagnosed cytology results were compared.ResultsA total of 478 EUS- FNA were performed in our institution. Fifteen patients (6M, 9F), mean age of 57 +/- 11.8 years (30-72 years) had repeated EUS-FNA done for the evaluation of possible malignant diseases. Eight of these patients presented with pancreatic masses and the other seven patients had unknown intra-abdominal lymphadenopathy. The second EUS-FNA diagnosed and was truly benign in 4 patients. Repeated EUS-FNA facilitated determination of the true status of the disease in 13 of 15 patients which 9 of whom were malignancy. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of repeated EUS-FNA for both inconclusive pancreatic masses and unknown intra-abdominal lymphadenopathy were 90%, 100%, 100%, 80% and 92.8% respectively.ConclusionRepeated EUS-FNA for inconclusive initial cytology of patients with suspected pancreatic cancer and unknown intra-abdominal lymphadenopathy provided a very high yield for definite tissue diagnosis and should be recommended.

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