Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

Abstract

Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs.

Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis).

Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %).

Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

Publikationsverlauf

Eingereicht: 15. Januar 2020

Angenommen: 23. März 2020

Artikel online veröffentlicht:
31. August 2020

• References

• 1 Li F, Malli A, Cruz-Monserrate Z. et al. Confocal endomicroscopy and cyst fluid molecular analysis: comprehensive evaluation of pancreatic cysts. World J Gastrointest Endosc 2018; 10: 1-9
• 2 Jana T, Shroff J, Bhutani MS. Pancreatic cystic neoplasms: review of current knowledge, diagnostic challenges, and management options. J Carcinog 2015; 14: 3
• 3 Kohoutova D, Zar S, Repak R. et al. Pancreatic cysts: diagnostic role of eus-guided microforceps biopsy and confocal laser endomicroscopy. Gastroenterol Res Pract 2019; 2019: 3431048 (Published online 2019 Sept 12)
• 4 Del Chiaro M, Verbeke C, Salvia R. et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45: 703-711
• 5 European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789-804
• 6 Martínez B, Martínez JF, Aparicio JR. Prevalence of incidental pancreatic cyst on upper endoscopic ultrasound. Ann Gastroenterol 2018; 31: 90-95
• 7 Gillis A, Cipollone I, Cousins G. et al. Does EUS-FNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review. HPB (Oxford) 2015; 17: 377-386
• 8 Krishna SG, Hart PA, Malli A. et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. Clin Gastroenterol Hepatol 2020; 18: 432-440e6
• 9 Aparicio JR, Martínez J, Niveiro M. et al. Direct intracystic biopsy and pancreatic cystoscopy through a 19-gauge needle EUS (with videos). Gastrointest Endosc 2010; 72: 1285-1288
• 10 Shakhatreh M, Naini S, Brijbassie A. et al. Use of a novel through-the-needle biopsy forceps in endoscopic ultrasound. Endosc Int Open 2016; 4: E439-E442
• 11 Attili F, Pagliari D, Rimba M. Endoscopic ultrasound-guided histological diagnosis of a mucinous non-neoplastic pancreatic cyst using a specially designed through-the-needle microforceps. Endoscopy 2016; 48: E188-E189
• 12 Huelsen A, Cooper C, Saad N. et al. Endoscopic ultrasound-guided, through-the-needle forceps biopsy in the assessment of an incidental large pancreatic cystic lesion with prior inconclusive fine-needle aspiration. Endoscopy 2017; 49: E109-E110
• 13 Cotton P, Eisen G, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 14 Barresi L, Crinò SF, Fabbri C. et al. Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A multicenter study. Dig Endosc 2018; 30: 760-770
• 15 Basar O, Yuksel O, Yang DJ. et al. Feasibility and safety of microforceps biopsy in the diagnosis of pancreatic cysts. Gastrointest Endosc 2018; 88: 79-86
• 16 Crinò S, Bernardoni L, Brozzi L. et al. Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. Gastrointest Endosc 2019; 90: 933-943
• 17 Kovacevic B, Karstensen J, Havre R. et al. Initial experience with EUS-guided microbiopsy forceps in diagnosing pancreatic cystic lesions: A multicenter feasibility study (with video). Endosc Ultrasound 2018; 7: 383-388
• 18 Mittal C, Obuch J, Hammad H. et al. Technical feasibility, diagnostic yield, and safety of microforceps biopsies during EUS evaluation of pancreatic cystic lesions (with video). Gastrointest Endosc 2018; 87: 1263-1269
• 19 Yang D, Samarasena J, Jamil L. et al. Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. Endosc Int Open 2018; 6: E1423-E1430
• 20 Yang D, Trindade A, Yachimski P. et al. Histologic analysis of endoscopic ultrasound-guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts. Clin Gastroenterol Hepatol 2019; 17: 1587-1596
• 21 Zhang M, Arpin R, Brugge W. et al. Moray micro forceps biopsy improves the diagnosis of specific pancreatic cysts. Cancer Cytopathol 2018; 126: 414-420
• 22 Munigala S, Gelrud A, Agarwal B. et al. Risk of pancreatic cancer in patients with pancreatic cyst. Gastrointest Endosc 2016; 84: 81-86
• 23 Zerboni G, Signoretti M, Crippa S. et al. Systematic review and meta-analysis: Prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology 2019; 19: 2-9
• 24 Farrell J. Prevalence, diagnosis and management of pancreatic cystic neoplasms: current status and future directions. Gut Liver 2015; 9: 571-589
• 25 Barresi L, Tarantino I, Ligresti D. et al. A new tissue acquisition technique in pancreatic cystic neoplasm: endoscopic ultrasound-guided through-the-needle forceps biopsy. Endoscopy 2015; 47: E297-E298
• 26 Coman R, Schlachterman A, Esnakula A. et al. EUS-guided, through-the-needle forceps: clenching down the diagnosis. Gastrointest Endosc 2016; 84: 372-373
• 27 Huelsen A, Cooper C, Saad N. et al. Endoscopic ultrasound-guided, through-the-needle forceps biopsy in the assessment of an incidental large pancreatic cystic lesion with prior inconclusive fine-needle aspiration. Endoscopy 2017; 49: E109-E110
• 28 Pham KD, Engjom T, Gjelberg Kollesete H. et al. Diagnosis of a mucinous pancreatic cyst and resection of an intracystic nodule using a novel through-the-needle micro forceps. Endoscopy 2016; 48: E125-E133
• 29 Samarasena J, Nakai Y, Shinoura S. et al. EUS-guided, through-the-needle forceps biopsy: a novel tissue acquisition technique. Gastrointest Endosc 2015; 81: 225-226
• 30 Nilsson L, Keane M, Shamali A. et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology 2016; 16: 1028-1036
• 31 Pitman M, Brugge W, Warshaw A. The value of cyst fluid analysis in the pre-operative evaluation of pancreatic cysts. J Gastrointest Oncol 2011; 2: 195-198
• 32 Cizginer S, Turner B, Bilge A. et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 2011; 40: 1024-1028
• 33 Zhan X, Wang B, Liu F. et al. Cyst fluid carcino embryonic antigen concentration and cytology by endosonography-guided fine needle aspiration in predicting malignant pancreatic mucinous cystic neoplasms. J Dig Dis 2013; 14: 191-195
• 34 Pitman MB, Genevay M, Yaeger K. et al. High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology. Cancer Cytopathol 2010; 118: 434-440
• 35 Springer S, Wang Y, Dal Molin M. et al. A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 2015; 149: 1501-1510