Cancer network pancreatic EUS FNA audit

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Cancer network pancreatic EUS FNA audit

• Friday 3rd March 2006
• Drs Bernard Stacey and Hugh Shepherd
• on behalf of
• The RHCH EUS Service

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RHCH referral administration

• Referral form faxed to Unit
• Hand-written
• RHCH notes generated
• Referrals scrutinised individually 2x/wk by HAS
  or HG
• Prioritsed
• Lists compiled

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Reports

• Electronically generated
• Mailed to referring doctor with pictures
• Copy to RHCH notes
• FNA / cyst analysis in approx 3 working days

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2005 data

• Collection period 6 months
• 184 total EUS cases
• 31 pancreatic FNA/Trucut

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Age distribution
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Referral sources
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Macroscopic EUS findings

• 18 pancreatic masses
• 8 pancreatic cysts
• 4 diffuse swelling

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• 29 FNA
• 1 Trucut

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Resource improvementsActual Future

• Cytologist in room
• Preparing slides
• 1 Consultant radiologist per list
• 2 linear scopes
• (2 radials,1 tumour probe)
• Extra alt Wed list
• Max capacity 10/week

• Referral letters in gt10
• CTs available in gt8 or
• Photocopies of CT reports in gt24
• Identify 2ww with tracking dates
• Current mean wait 12.7 days

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Stated indication No. Mean wait (days)
Pancreatic cancer 13 7
Pancreatic cyst 8 17
Dilated CBD /- jaundice 9 16
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Normal ductal epithelial cells
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mucin
13
Epithelial cells with poor cohesion and single
cells
poorly cohesive groups
14
Malignant cells (adenocarcinoma)
cluster of pleomorphic cells
red blood cells
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Malignant cells (adenocarcinoma)
pleomorphic cells
red blood cells
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Cytology results

• Definite for malignancy 9
• Suspicious for malignancy 11
• Cellular atypia 3
• Benign cellular material 7
• Insufficient sample 0

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FNA of pancreatic lesions 2003
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FNA of pancreatic lesions 2004
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Cytology hit rate
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Collaterals and vessel involvement

• 6 / 21 in malignant or suspicious
• 0 / 11 in atypical or benign

• 7 / 21 in malignant or suspicious
• 0 / 11 in atypical or benign

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Surgical resection - 1

• 71 yo male, CBD stricture seen at ERCP, CTs not
  available at time of EUS
• EUS - 25 x 25mm mass in HoP. Close to, but
  separate from PV. Dilated CBD 12mm.
• EUS to surgery time 47 days
• Resection specimen pT3 N1a (1/22 nodes)

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20 definite / possible malignancies

• Metastases / ascites in 7 (35)
• Collaterals in 6 (30)
• PV/SMV abuttment/adherence in 7 (35)
• 2 had no collaterals/mets
• 15 cases
• 1 resected 16
• The other 4.
• 1 awaiting surgery
• Leaves
• 75 yo male (T2 N1 at EUS) S, 179 days (QA)
• 70 yo female (IPMT at EUS) S, 57 days (SUHT)
• 49 yo female (hard, diffuse CBD thickening at
  EUS, Ca 19-9 63.7) S,95 days (RHCH) - under
  oncologists

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Information out

• 8 / 30 (27) give data on collaterals (Y/N)
• Tumour size in 10 (50)
• Diffuse in 2 more
• In the other 8
• All had ve information on collaterals/vascular
  invasion/metastases

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Benign / atypical 10 cases

• 7 Benign
• 6 alive and benign disease course
• 47yo female pancreatic cyst fluid CEA 227.7
• (Serum CA19-9 lt2.5 last week)
• 1 alive but malignancy diagnosed
• (Liver mets seen on trans-abdominal USS and MRI)
• 3 Atypical
• 3 died from malignancy

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Patients with pancreatic cancer Patients without pancreatic cancer
FNA abnormal 23 0
FNA normal 1 6
Sensitivity 23/24 96
Specificity 6/6 100
atypicals?