ArticleEndoscopic ultrasound
Risk factors and a prediction model for false-negative diagnosis in repeat EUS-FNA/B of pancreatic solid lesions following initially nondiagnostic or inconclusive findings.
Article in Endoscopic ultrasound. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Objectives: Repeated EUS-guided fine-needle aspiration/biopsy (rEUS-FNA/B) is recommended in solid pancreatic lesions (SPLs) with inconclusive initial results. However, even rEUS-FNA/B cannot completely eliminate false negatives in challenging cases. This study aims to identify risk factors of false-negative results in rEUS-FNA/B and develop a prediction model. Methods: Data of patients who had an initial inconclusive diagnosis and underwent rEUS-FNA/B for SPLs across 8 Chinese medical centers from January 2013 to June 2024 were retrospectively reviewed. Logistic regression was performed to identify the risk factors of false-negative results in rEUS-FNA/B. A clinical prediction model using a random forest algorithm was developed with leave-one-hospital-out cross-validation. Results: A total of 230 patients were enrolled in this study. Among them,159 patients (69.1%) were diagnosed with malignancies, while 71 patients (30.8%) had benign lesions. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of rEUS-FNA/B was 78.26%, 68.55%, 100%, 100%, and 58.68%. At multivariate analysis, lesion size 20-40 mm (odds ratio [OR] 0.26), lesion size ≥40 mm (OR 0.20), ≤2 needle passes (OR 3.1), and no liquid-based cytology (LBC) examination (OR 3.95) were found to be independently associated with false-negative results. A final random forest model with 4 features (lesion size, rEUS-FNA/B needle type, LBC, and smear cytology) showed moderate ability to distinguish false-negative results in both training (area under the receiver operating characteristic curve = 0.78) and validation sets (area under the receiver operating characteristic curve = 0.68). Conclusion: To minimize false-negative outcomes during rEUS-FNA/B, LBC is strongly recommended. Additionally, SPLs with a maximum diameter of ≤20 mm exhibit a higher probability for producing false-negative results during rEUS-FNA/B procedures.
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