The Application of EUS-guided FNA in the Diagnosis of Pancreatic Neoplasms in the Elderly

Summary: Background: Endoscopic ultrasound guided fine needle aspiration has become a standard procedure in diagnosis of pancreatic neoplasms with a high diagnosis yield. However, the clinical application focusing on the elderly population is scanty. Methods: Consecutive procedures for EUS-FNA diagnosis of pancreatic neoplasms at a tertiary referral center from March 2014 to December 2015 were analyzed retrospectively. The procedures were divided into two groups according to their age, the control group consisted of patients ≤60 years old and the elderly groups consisted of patients >60 years old. The primary outcome is the accuracy of the diagnosis in the two groups. The secondary outcome is the safety during the procedure. Results: A total of 28 EUS-FNA procedures were performed. The mean age of the control group was 48.7 years (n = 14) versus 70.2 years (n = 14) for the elderly cohort. Diagnostic accuracy of the EUS-FNA procedure in detecting malignant (true positive) and benign (true negative) lesions were higher in the control group (nonelderly: 85.7% vs. elderly: 50%; P = 0.046). There were two mild acute pancreatitis associated to the EUS-FNA procedures in the control group. Conclusion: Although EUS-FNA is safe and well tolerated in the elderly patients, our study showed a lower EUS-FNA diagnosis accuracy in this group. Focal fibrotic changes in the pancreas associated with the elderly patients resembled that of chronic pancreatitis microscopically. Keywords: EUS-FNA, pancreatic neoplasms, elderly, endoscopy, diagnosis