Comparative diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for tissue sampling of solid pancreatic lesions without ROSE

Aims Endoscopic ultrasound-guided tissue sampling plays a central role in the accurate diagnosis of solid pancreatic lesions. The aim of our study was to identify factors improving the diagnostic yield of endoscopic ultrasound-guided tissue acquisition in solid pancreatic lesions [1].

Methods We conducted an ambispective and analytical study between January 2022 and september 2024. We included all patients with solid pancreatic lesions who underwent an endoscopic ultrasound-guided sampling. Three types of needles were used: 1- 22G fine needle aspiration (FNA) needles, 2- newer generation 22G fine needle biopsy (FNB) needles, and 3- 19G FNA needles. For each patient, we performed an average of two needle passes, with fanning systematically performed. Additionally, suction was used during sampling with FNA needles and we evaluated the quality of all the samples by Macroscopic On-Site Evaluation (MOSE) (presence of white core tissue).

Results 54 patients were included in our study. The mean age was 59.6+/- 15 years. The sex ratio was 1.5. 23 patients underwent UES-FNA, while 31 patients underwent EUS-FNB. In our series, the overall diagnostic yield of EUS-guided sampling was 63.6%. 88.2% of biopsies performed using FNB needles were conclusive compared to 31.7% when FNA needles were used. The diagnostic accuracy of 19G FNA needles was 81%. In pairwise comparison, the presence of adequate tissue core was significantly higher in the FNB group (p-value=0.006). In multivariate analysis, after adjusting for covariates (age, sex, size of the pancreatic mass on endoscopic ultrasound examination, and type of needle used), only the size of the lesion (p=0.04) and the use of newer generation FNB needles (p=0.03) were associated with obtaining a positive histopathological diagnosis. The anatomical location of the lesion (head/body/tail) did not influence the diagnostic accuracy (p value=0,5)

Conclusions Newer generation FNB needles appear to offer a greater diagnostic performance in the sampling of solid pancreatic masses when Rapid On-Site Evaluation is not available. These results have immediate clinical practice implications and could help endoscopists meet the quality indicator threshold of having a sensitivity that equals or exceeds 85%, as advocated by European and American societies of gastroenterology.

Publication History

Article published online:
27 March 2025

• References

• 1 ASGE Standards of Practice Committee Chair, ASGE Standards of Practice Committee. Machicado JD, Sheth SG, Chalhoub JM, Forbes N, Desai M, Ngamruengphong S, Papachristou GI, Sahai V, Nassour I, Abidi W, Alipour O, Amateau SK, Coelho-Prabhu N, Cosgrove N, Elhanafi SE, Fujii-Lau LL, Kohli DR, Marya NB, Pawa S, Ruan W, Thiruvengadam NR, Thosani NC, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis and management of solid pancreatic masses: summary and recommendations Gastrointest Endosc. 2024; S0016-5107(24)03255-3 doi:10.1016/j.gie.2024.06.002 Epub ahead of print. PMID: 39387777.