Percutaneous Versus EUS FNAC in Pancreatic Masses
Percutaneous Versus EUS FNAC in Pancreatic Masses
We aim to evaluate the role of Ultrasound-guided (USG) fine needle aspiration cytology (FNAC)
 in diagnosis of pancreatic masses compared to endoscopic ultrasound (EUS) guided fine needle
 aspiration cytology (FNAC).
Pancreatic cancer is the fourth leading cause of cancer-related mortality in the United
 States. Over 45,000 patients are diagnosed each year in the United States, and the majority
 of these patients succumb to their disease. Eighty percentages of patients are diagnosed with
 advanced, unrespectable disease. According to the latest statistics, only 7 % of patients
 survive 5 years after diagnosis. While the 5-year survival rate improves to 25 % in patients
 presenting with stage 1or localized disease, only 9 % of patients are identified at this
 early stage. The majority of patients (53%) presents with distant metastatic disease, and
 have a 5-year survival of 2%.

 Improving the prognosis of patients with pancreatic cancer is a challenge. Overall,
 pancreatic cancer has one of the worst prognoses among all cancers; however, the prognosis is
 better if cancer is detected at an early stage. For example, patients with pancreatic cancers
 ≤1 cm in size at the time of diagnosis have a 5-year survival rate of 80.4% . Because such
 small cancers now account for 0.8% of all pancreatic cancer, detection of more small cancers
 would contribute to improving mortality rates.

 The diagnostic approach to a possible pancreatic mass lesion relies first upon various
 non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic
 resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition
 for characterization of the lesion is often paramount in developing an individualized
 therapeutic approach. Tools , in addition to radiologic imaging , currently employed in the
 initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers ,
 endoscopic retrograde cholangiopancreatography, Ultrasound-guided (USG) fine needle
 aspiration cytology (FNAC) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)
 .

 Advancements in radiologic and endoscopic ultrasound (EUS) imaging have improved our ability
 to detect and stage pancreatic masses allowing for more selective surgical intervention for
 patients with resectable disease. Owing to the low sensitivity of cross-sectional imaging to
 detect small tumors in the pancreas.

 Endoscopic ultrasound (EUS), in which the tip of the endoscope contains a high-frequency
 transducer , provides high resolution images of the pancreas. Indeed , its high resolution in
 experienced hands enables detection of focal lesions as small as 2-5 mm .

 Ultrasound-guided (USG) fine needle aspiration cytology (FNAC) has emerged as a primary
 diagnostic modality in investigation in patients with pancreatic lesions. This technique was
 introduced into clinical practice nearly 3 decades ago and has proved to be a simple,
 cost-effective and minimally invasive technique that can yield material for tissue diagnosis
 .
Inclusion Criteria:

 -  50 Patients in different sex & age groups with pancreatic masses

 Exclusion Criteria:

 -  Any general contraindications for FNAC or EUS in some cases as Coagulopathy with INR
 >1.5 or platelet count <50,000/mmc, Antithrombotic therapy.