Artículo Original 1Departamento de Gastroenterología. 2Escuela de Medicina. 3Departamento de Anatomía Patológica. 4Departamento de Cirugía D igestiva. Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 63 Financiamiento: Ninguno. Recibido: 11 de abril de 2017 Aceptado: 26 de mayo de 2017 Correspondencia a: Dr. Alberto Espino Unidad Endoscopia Hospital Clínico UC-Christus. Diagonal Paraguay 362. 4° piso. Santiago-Chile. Teléfono: +56 2 23543822 albertoespinomed@ gmail.com Gastroenterol. latinoam 2017; Vol 28, Nº 2: 63-69 Evaluación rápida “in situ” de punción con aguja fina guiada por endosonografía mejora rendimiento diagnóstico de lesiones pancreáticas sólidas José Ignacio Vargas D.1, Sebastián Muñoz G.2, Rodrigo Mansilla V.1, Javiera Torres M.3, Juan Carlos Roa S.3, Kenneth Walker B.3, Ignacio Duarte G. de C.3, Ricardo Mejía M.4, Hugo Richter R.1, Robinson González D.1 y Alberto Espino E.1 Rapid on-site evaluation with endoscopic ultra sound-guided fine needle improves diagnostic yield of solid pancreatic masses Background: The use of endoscopic ultrasound with fine needle aspiration (EUS-FNA) has improved the characterization and staging of pancreatic solid masses. The primary strategy for improving the ability to diagnose malignant masses is the use of rapid on site evaluation (ROSE) by a cytopathologist. Objective: To evaluate the diagnostic yield of EUS-FNA after the implementation of ROSE in an academic center. Material and Methods: Prospective enrollment and follow-up of EUS-FNA with ROSE during 2015 and 2016, was compared to EUS-FNA without ROSE in previous years (2011-2014) in Hospital Clínico UCChristus. Clinical and endosonographic features, cytopathological and histological diagnosis and number of passes per procedure were evaluated. All EUS-FNA included cytology and cellular block for definitive diagnosis. Results: 59 pancreatic solid masses were included in the analysis. 44 EUS-FNA were performed with ROSE, compared with 15 EUS-FNA without ROSE. The mean age of patients included was 62.8 years, 54.2% male gender, and most masses studied were in the head of pancreas (77.6%). In EUS 86.5% were hypoechoic and 56.9% had poor defined margins. No differences in baseline characteristics were observed between groups. EUS-FNA led to diagnosis in 86.2% of the overall sample. The diagnostic rate was superior in the group of EUS-FNA with ROSE, compared to EUS-FNA without ROSE (97.7% vs 50%, p < 0.0001). The mean number of passes was inferior in EUS-FNA ROSE (+) (2.71 vs 5.78, p < 0.0001). No differences in rate of complications were observed between groups. Conclusion: The use of ROSE associated to EUS-FNA improves the diagnostic yield in the evaluation of pancreatic solid masses. Our findings are consistent with those described in the literature, recommending the use of ROSE in EUS-FNA in centers where the diagnostic yield is less than 90% without the use of ROSE. Key words: Endosonography; endoscopic ultrasound; fine needle aspiration; solid pancreatic masses; rapid on-site evaluation; pancreatic cancer. Resumen Introducción: La adquisición de tejido mediante el uso de endosonografía, con punción con aguja fina, (EUS-FNA) ha mejorado el diagnóstico de lesiones pancreáticas sólidas. La principal medida para aumentar el rendimiento diagnóstico de la EUS-FNA es la evaluación por citopatólogo próximo al lugar de punción (in situ) (técnica conocida en inglés como ROSE “rapid on-site evaluation”). Objetivo: Evaluar el rendimiento diagnóstico de EUS-FNA en lesiones pancreáticas sólidas posterior a la implementación de ROSE en un centro universitario. Material y Métodos: Registro prospectivo de EUS-FNA realizadas con ROSE durante el período 2015-2016, comparado con EUS-FNA con evaluación histopatológica diferida realizada entre los años 2011-2014, en Hospital Clínico UC-Christus. Se evaluaron características clínicas, endosonográficas, diagnóstico histopatológico y número de pases por procedimiento. Todas las EUS-FNA incluyeron citología y block celular para diagnóstico definitivo. Resultados: Se incluyeron en el análisis 59 lesiones pancreáticas sólidas evaluadas con EUS-FNA. Seguimiento prospectivo de 44 EUS-FNA con ROSE, que fueron comparadas con 15 EUS-FNA sin evaluación in situ (retrospectivo). La muestra total incluyó individuos con un promedio de 62,8 años de edad, 54,2% hombres, donde 77,6%
gastrolat 2 2017
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