Intraoperative fine needle aspiration cytologic examination of pancreatic lesions

Despite the possibilities in modern imaging technology and percutaneous biopsy, a surgeon may still find an undiagnosed mass in the pancreas at laparotomy. In this situation, intraoperative fine needle aspiration cytologic (IFNAC) examination has been reported to be helpful. We reviewed our experiences with IFNAC in 98 patients. Fifty patients had a malignant pancreatic tumor as verified on histologic examination. The results of IFNAC correctly suggested a malignant tumor in 35 patients, for an initial sensitivity of 70 per cent. Re-examination of the slides resulted in 81 per cent sensitivity, which was not a significant improvement. The sensitivity rate (an average of 83 per cent in the literature) does not, however, express enough the unreliability of the method in individual patients. We conclude that, although IFNAC correctly differentiates between carcinoma and benign pancreatic diseases in most instances, the justification for pancreas resection cannot always be based on cytologic findings, but rather on clinical and laparotomy findings.