Hima Prabhakar MD, Presenter: Nothing to Disclose

Dushyant Vasudeo Sahani MD, Abstract Co-Author: Nothing to Disclose

Ruben Rodriguez MD, Abstract Co-Author: Nothing to Disclose

Chad Brian Rabinowitz MD, Abstract Co-Author: Nothing to Disclose

Carlos Fernandez-del Castillo MD, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Consultant, Cook Group Incorporated, Bloomington, IN

Necrotizing pancreatitis is associated with high morbidity and mortality. Current treatment recommendations focus on initial conservative management in most patients; however surgical intervention is necessary in those patients with proven infected pancreatic necrosis because of associated increased mortality. Given the impact of positive culture results on patient management, it is important to establish a diagnosis of infected pancreatic necrosis. The purpose of this study was to determine the sensitivity and specificity of image guided percutaneous fine needle aspiration (FNA) in the diagnosis of infected pancreatic necrosis.

167 patients undergoing necrosectomy for necrotizing pancreatitis between 1/90-8/05 were retrospectively reviewed to determine which patients had FNA to diagnose infected pancreatic collections prior to surgery. Microbiology results from FNA was compared with cultures obtained intraoperatively to determine the sensitivity, specificity, and positive and negative predictive values of percutaneous FNA.

71/167 patients had both percutaneous FNA of pancreatic necrosis prior to surgery and intraoperative cultures. 49/71 patients had FNA cultures positive for infection; 46 of these patients had intraoperative cultures positive for infection (PPV=94%). 22/71 patients had negative FNA cultures;6 of these patients had positive intraoperative cultures (NPV=27%). 52/71 patients had positive intraoperative cultures; 46 of these patients had positive FNA cultures (sensitivity=88%). 19/71 patients had negative intraoperative cultures; 16 of these patients also had negative FNA cultures (specificity=84%). 3/49 patients had false positive FNA results compared to intraoperative cultures, however this may be due to the routine use of antibiotics prior to surgery in these patients.

Percutaneous FNA is sensitive and specific in diagnosing infected pancreatic necrosis and may be useful in determining which patients could benefit from early debridement compared to conservative management.

Percutaneous FNA is useful in establishing a diagnosis of infected pancreatic necrosis, and can triage patients to early debridement versus conservative management.

Prabhakar, H, Sahani, D, Rodriguez, R, Rabinowitz, C, Fernandez-del Castillo, C, Mueller, P, Role of Image Guided Fine Needle Aspiration in the Diagnosis of Infected Necrotizing Pancreatitis: Observations Over a 15 Year Period.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4439313.html