False-positive EUS-guided FNA cytology for solid pancreatic lesions

Ali A. Siddiqui, Thomas E. Kowalski, Haroon Shahid, Sean O'Donnell, Joanna Tolin, David E. Loren, Anthony Infantolino, Shih Kuang Hong, Mohamad A. Eloubeidi

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Background: The currently accepted paradigm is that the false-positive (FP) rate for EUS-guided fine-needle aspiration (EUS-FNA) cytologic analysis of a pancreatic lesion is less than 1%. Objective: To assess the FP rate of EUS-FNA in patients who underwent surgical resection for presumed pancreatic cancer. Design: Retrospective study. Setting: Tertiary-care referral center. Patients: This study involved 367 patients with solid pancreatic lesions in whom EUS-FNA cytology results were interpreted as positive or suspicious for malignancy, which resulted in subsequent surgical resection. Intervention: Surgical resection. Main Outcome Measurements: The FP diagnosis was defined as EUS-FNA cytology specimens being reported as "positive" or "suspicious for malignancy" but that were later proven to be benign on surgical pathology. Results: The FP rate for EUS-FNA was 4 of 367 (1.1%) when only "positive" cytology findings were interpreted as malignant and 14 of 367 (3.8%) when both suspicious and positive cytology findings were interpreted as malignant. Among the 4 cases falsely interpreted as positive, 1 was falsely diagnosed cytologically as a neuroendocrine tumor and 3 as adenocarcinomas. All FP specimens showed chronic pancreatitis on surgical pathology. The incidence of discordance between cytology and surgical pathology did not change over time (2000-2006: 8/188 [4.3%] vs 2007-2010: 6/179 [3.4%]; P =.79). Limitations: Retrospective study at a single center. Conclusion: In a retrospective cohort trial, the FP rate for EUS-FNA of solid pancreatic lesions was 1.1%. Findings of the current study are in line with previous studies that have evaluated the FP cytology rates with EUS-FNA of solid lesions. FP cases transpired primarily as a result of cytologic misinterpretation in the setting of chronic pancreatitis.

Original languageEnglish (US)
Pages (from-to)535-540
Number of pages6
JournalGastrointestinal Endoscopy
Issue number3
StatePublished - Sep 2011

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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