S3378 Yield of Pancreatic Head Fine Needle Aspiration Is Not Affected by Prior Biliary Stent Placement
Bibliographic record
Abstract
Introduction: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is the diagnostic modality for obtaining a tissue diagnosis of potential pancreatic malignancy in patients. Patients commonly undergo ERCP with biliary stenting for symptomatic relief of obstructive jaundice via biliary decompression and initial endoscopic evaluation of suspected pancreatic cancer. To date, studies are conflicting regarding the impact of prior biliary stenting on EUS-FNA diagnostic yield. Methods: Pancreatic fine needle aspirations (FNA) performed at our center over an 8-year period (2012 - 2020) were identified by searching the pathology laboratory electronic medical record for the specimen types ‘pancreas FNA’. Age, sex, lesion location and size, final pathologic diagnosis, and timing of stent placement relative to biopsy, were recorded from chart review. FNA interpretation was taken from the final pathology report and classified as either diagnostic or non-diagnostic, as per standard reporting process. The association between diagnostic FNA and prior stent placement was assessed using Fisher’s exact test. Confidence interval (CI) of diagnostic yield was calculated using the modified Wald method. Results: Among the 162 patients, 56% were male, mean age was 66. 77% of patients did not have a biliary stent placed before FNA. 68% of lesions were found in the head, neck or uncinate of the pancreas. Of patients who underwent FNA without prior stent placement, 70.4% were diagnostic (95% CI: 63%-78%). Of patients who underwent FNA after stent placement, 78.4% were diagnostic (95% CI: 65%-92%). The difference was not statistically significant (P = 0.407). Similar analysis was performed in patients with lesions only in the head, neck and uncinate region. Within that subgroup, 70.8% of stented lesions were diagnostic (95% CI: 61%-81%), compared to 77.4% of unstented lesions being diagnostic (95% CI: 60%-89%). The difference was not statistically significant (P = 0.635). Conclusion: Prior placement of a biliary stent was not associated with a significant difference in diagnostic yield of EUS-FNA patients suspected of having pancreatic cancer, including those with lesions specifically located in the head, neck and uncinate region. Therefore, our analysis suggests that in situations when biliary stenting prior to aspiration is indicated or if prior EUS-FNA is impractical, clinicians can be reassured that future diagnostic yield will likely not be affected.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".