Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) material in the differential diagnosis of pancreatic solid masses.METHODS Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs (22G needle) were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Materials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study.RESULTS Length of the core specimen obtained for histological analysis was 6.5 5.3 mm (range 1-22 mm).Cytological and histological samples were considered as adequate in 51 (82.3%) and 52 cases (83.9%), respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Contrary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases (90.3%),with a global sensitivity of 84.21%, specificity of 100%and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.     

内镜超声及其引导下的细针穿刺活检在胰腺疾病中的诊断价值

目的:探讨内镜超声(EUS)及其引导下的细针穿刺活检(EUS-FNA)在胰腺疾病诊断中的价值.方法:回顾性分析2008-03/2010-03经EUS检查的62例胰腺疾病,其中有32例行细针穿刺活检.结果:(1)62例胰腺疾病中胰腺癌26例、慢性胰腺炎20例、胰腺囊肿10例、胰岛细胞瘤2例;(2)B超、CT、EUS/EU...     

Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions

Backgrounds: Percutaneous ultrasound (US) and endoscopic ultrasound (EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases. Studies comparing the diagnostic performance of US- and EUS-guided pancreatic biopsies are lacking. This study aimed to evaluate and compare the diagnostic yields of US- and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies.Methods: Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center, 275 underwent EUS-guided fine needle aspiration (EUS-FNA), and 799 underwent US-guided core needle biopsy (US-CNB/FNA). The outcomes were inconclusive pathological biopsy, diagnostic accuracy and the need for repeat biopsy. All of the included factors and diagnostic performances of both US-CNB/FNA and EUS-FNA were compared, and the independent predictors for the study outcomes were identified.Results: The diagnostic accuracy was 89.8% for EUS-FNA and 95.2% for US-CNB/FNA ( P = 0.001). Biopsy under EUS guidance [odds ratio (OR) = 1.808, 95% confidence interval (CI): 1.083-3.019; P = 0.024], lesion size < 2 cm (OR = 2.069, 95% CI: 1.145-3.737; P = 0.016), hypoechoic appearance (OR = 0.274, 95% CI: 0.097-0.775; P = 0.015) and non-pancreatic ductal adenocarcinoma carcinoma (PDAC) diagnosis (OR = 2.637, 95% CI: 1.563-4.449; P < 0.001) were identified as factors associated with inconclusive pathological biopsy. Hypoechoic appearance (OR = 0.236, 95% CI: 0.064-0.869; P = 0.030), lesions in the uncinate process of the pancreas (OR = 3.506, 95% CI: 1.831-6.713; P < 0.001) and non-PDAC diagnosis (OR = 2.622, 95% CI: 1.278-5.377; P = 0.009) were independent predictors for repeat biopsy. Biopsy under EUS guidance (OR = 2.024, 95% CI: 1.195-3.429; P = 0.009), lesions in the uncinate process of the pancreas (OR = 1.776, 95% CI: 1.014-3.108; P = 0.044) and hypoechoic appearance (OR = 0.127, 95% CI: 0.047-0.347; P < 0.001) were associated with diagnostic accuracy.Conclusions: Both percutaneous US- and EUS-guided biopsies of solid pancreatic lesions are safe and effective; though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA. A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.     

22-gauge core vs 22-gauge aspiration needle for endoscopic ultrasound-guided sampling of abdominal masses

AIM To compare the aspiration needle(AN) and core biopsy needle(PC) in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) of abdominal masses.METHODS Consecutive patients referred for EUS-FNA were included in this prospective single-center trial. Each patient underwent a puncture of the lesion with both standard 22-gauge(G) AN(Echo Tip Ultra; Cook Medical, Bloomington, Indiana, United States) and the novel 22 G PC(Echo Tip Pro Core; Cook Medical, Bloomington, Indiana, United States) in a randomized fashion; histology was attempted in the PC group only. The main study endpoint was the overall diagnostic accuracy, including the contribution of histology to the final diagnosis. Secondary outcome measures included material adequacy, number of needle passes, and complications.RESULTS Fifty six consecutive patients(29 men; mean age 68 years) with pancreatic lesions(n = 38), lymphadenopathy(n = 13), submucosal tumors(n = 4), or others lesions(n = 1) underwent EUS-FNA using both of the needles in a randomized order. AN and PC reached similar overall results for diagnostic accuracy(AN: 88.9 vs PC: 96.1, P = 0.25), specimen adequacy(AN: 96.4% vs PC: 91.1%, P = 0.38), mean number of passes(AN: 1.5 vs PC: 1.7, P = 0.14), mean cellularity score(AN: 1.7 vs PC: 1.1, P = 0.058), and complications(none). A diagnosis on the basis of histology was achieved in the PC group in 36(64.3%) patients, and in 2 of those as the sole modality. In patients with available histology the mean cellularity score was higher for AN(AN: 1.7 vs PC: 1.0, P = 0.034); no other differences were of statistical significance.CONCLUSION Both needles achieved high overall diagnostic yields and similar performance characteristics for cytological diagnosis; histological analysis was only possible in 2/3 of cases with the new needle.     

内镜超声引导细针穿刺对胰腺癌的诊断价值

目的了解内镜超声(EUS)引导细针穿刺(FNA)对胰腺癌的临床价值及安全性。方法选择临床诊断或临床及影像学疑诊胰腺癌患者共21例,男13例,女8例,平均年龄(59.8±15.3)岁。EUS发现病变后,在实时超声引导下用超声穿刺针行FNA,对3例无法手术的胰腺癌患者行FNA同时,以无水乙醇阻滞腹腔神经丛治疗癌痛。结果B超共检出胰腺占位16例(16/21),未检出的5例中3例经CT检出,CT共检出胰腺占位19例;EUS检出全部21例胰腺占位,5例位于胰体尾,16例位于胰头。18例患者EUS-FNA获满意标本,17例诊断为胰腺癌,1例诊断为慢性胰腺炎,胰腺癌诊断敏感性为85.0%、特异性为100.0%、准确度为85.7%。3例行无水乙醇阻滞后疼痛减轻。术后发生轻度胰腺炎1例、发热1例。结论EUS能有效检出胰腺占位,结合FNA可提高诊断的特异性及准确性。     

Endoscopic ultrasound-guided tissue acquisition of pancreatic masses

Endoscopic ultrasound (EUS) has assumed an increasing role in the management of pancreaticobiliary disease over the past 2 decades but its impact is particularly evident in the management of pancreatic masses. EUS helps improve patients′ outcomes by enhancing tumor detection and staging while providing safe and reliable tissue diagnosis. This review provides an evidence-based approach to the use of EUS for the diagnosis of pancreatic cancer, its staging, and for the determination of resectability compared to other imaging modalities. We will focus on techniques specific to obtaining tissue from solid pancreatic masses and will review best practices in EUS-guided tissue acquisition.     

Improved diagnostic yield of endoscopic ultrasound-fine needle biopsy with histology specimen processing

BACKGROUND Endoscopic ultrasound-guided fine needle biopsy(EUS-FNB) has emerged as a safe, efficacious alternative to fine needle aspiration(FNA) for tissue acquisition. EUS-FNB is reported to have higher diagnostic yield while preserving specimen tissue architecture. However, data on the optimal method of EUS-FNB specimen processing is limited.AIM To evaluate EUS-FNB with specimen processing as histology vs EUS-FNA cytology with regards to diagnostic yield and specimen adequacy.METHODS All EUS-FNA and EUS-FNB performed at our institution from July 1, 2016, to January 31, 2018, were retrospectively analyzed. We collected data on demographics, EUS findings, pathology, clinical outcomes, and procedural complications in two periods, July 2016 through March 2017, and April 2017 through January 2018, with predominant use of FNB in the second data collection time period. FNA specimens were processed as cytology with cell block technique and reviewed by a cytopathologist; FNB specimens were fixed in formalin, processed for histopathologic analysis and immunohistochemical staining, and reviewed by an anatomic pathologist. Final diagnosis was based on surgical pathology when available, repeat biopsy or imaging, and length of clinical follow up.RESULTS One hundred six EUS-FNA and EUS-FNB procedures were performed. FNA alone was performed in 17 patients; in 56 patients, FNB alone was done; and in 33 patients, both FNA and FNB were performed. For all indications, diagnostic yield was 47.1%(8/17) in FNA alone cases, 85.7%(48/56) in FNB alone cases, and 84.8%(28/33) in cases where both FNA and FNB were performed(P = 0.0039). Specimens were adequate for pathologic evaluation in 52.9%(9/17) of FNA alone cases, in 89.3%(50/56) of FNB alone cases, and 84.8%(28/33) in cases where FNA with FNB were performed(P = 0.0049). Tissue could not be aspirated for cytology in 10.0%(5/50) of cases where FNA was done, while in 3.4%(3/89) of FNB cases, tissue could not be obtained for histology. In patients who underwent FNA with FNB, there was a statistically significant difference in both specimen adequacy(P = 0.0455) and diagnostic yield(P = 0.0455) between the FNA and FNB specimens(processed correspondingly as cytology or histology).CONCLUSION EUS-FNB has a higher diagnostic yield and specimen adequacy than EUS-FNA. In our experience, specimen processing as histology may have contributed to the overall increased diagnostic yield of EUS-FNB.     

Ultrasound-guided vs endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer diagnosis

AIM: To clarify the effectiveness and safety of endo- scopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of pancreatic cancer (PC). METHODS: Patients who were diagnosed with unresectable, locally advanced or metastatic PC between February 2006 and September 2011 were selected for this retrospective study. FNA biopsy for pancreatic tumors had been performed percutaneously under extracorporeal ultrasound guidance until October 2009; then, beginning in November 2009, EUS-FNA has been performed. We reviewed the complete medical records of all patients who met the selection criteria for the following data: sex, age, location and size of the targeted tumor, histological and/or cytological findings, details of puncture procedures, time from day of puncture until day of definitive diagnosis, and details of severe adverse events. RESULTS: Of the 121 patients who met the selection criteria, 46 had a percutaneous biopsy (Group A) and 75 had an EUS-FNA biopsy (Group B). Adequate cytological specimens were obtained in 42 Group A patients (91.3%) and all 75 Group B patients (P=0.0192), and histological specimens were obtained in 41 Group A patients (89.1%) and 65 Group B patients (86.7%). Diagnosis of malignancy by cytology was positive in 33 Group A patients (78.6%) and 72 Group B patients (94.6%) (P=0.0079). Malignancy by both cytology and pathology was found in 43 Group A (93.5%) and 73 Group B (97.3%) patients. The mean period from the puncture until the cytological diagnosis in Group B was 1.7 d, which was significantly shorter than that in Group A (4.1 d) (P < 0.0001). Severe adverse events were experienced in two Group A patients (4.3%) and in one Group B patient (1.3%). CONCLUSION: EUS-FNA, as well as percutaneous needle aspiration, is an effective modality to obtain cytopathological confirmation in patients with advanced PC.     

内镜超声引导下细针穿刺对胰腺占位病变的诊断价值

目的 通过超声内镜结合细针穿刺活检确定胰腺占位病变的性质，并评价该法对胰腺病变的诊断价值。方法 对经CT、MRI、体表腹部超声及内镜超声发现的23例胰腺局限性占位病变进行内镜超声检查，以明确病变大小、形态、位置，并观察有无淋巴结转移。在内镜超声引导下对病变行细针穿刺活检。结果 23例患者中，21例得到了充足的细胞量，15例得到组织块，12例最终确定为胰腺肿瘤的患者，经组织细胞学检查10例为阳性（其中胰腺癌8例；胰腺囊腺瘤癌1例；无功能神经内分泌肿瘤1例），敏感性为83％，特异性为100％。全部结果经手术（16例）及临床随访（7例）证实。无1例出现不良反应。结论 超声内镜结合细针穿刺是诊断胰腺病变安全、有效的方法。     

Simultaneous endoscopic ultrasound fine needle aspiration and endoscopic retrograde cholangio-pancreatography： Evaluation of safety

AIM： To investigate the rate of complications of endoscopic retrograde cholangio-pancreatography （ERCP） performed immediately after endoscopic ultrasound fine needle aspiration （EUS-FNA） in a large series of patients.
METHODS： Patients with the following conditions were considered candidates for EUS-FNA and ERCP： diagnosis of locally advanced or metastatic pancreatic lesion not eligible for surgery, and patients with pancreatic lesion of unknown nature causing jaundice. Data were prospectively collected on the following parameters： indication for FNA, EUS findings, pathological diagnosis, procedure duration of EUS-FNA and combined EUS-FNA and ERCP, and immediate and late complications.
RESULTS： From January 2004 to October 2006, 72 patients were deemed eligible for combined EUS and ERCP. In 25/72 EUS-FNA was performed to obtain a pathology diagnosis of lesions causing biliary obstruction, and ERCP sequentially performed to drain the biliary system. No immediate complications occurred except for two mild bleeding episodes post sphincterotomy. No late complications were recorded except for one patient who experienced fever, promptly recovered with antibiotic therapy.
CONCLUSION： Simultaneous approach appears to be feasible and safe. When possible, this can be considered the reference standard to avoid double sedation and reduce duration of the procedure and hospital stay.     

Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

AIM:To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in a cohort of pancreatic cancer patients.METHODS:Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011,82were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings.Of these,54 underwent EUS-FNA before surgery(FNA+group)and 28 underwent surgery without preoperative EUSFNA(FNA-group).RESULTS:All 54 lesions were visible on EUS,and all54 attempts at FNA were technically successful.The diagnostic accuracy according to cytology and histology findings was 98.1%(53/54)and 77.8%(42/54),respectively,and the total accuracy was 98.1%(53/54).One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy.No severe complications occurred after EUS-FNA.In the FNA+and FNA-groups,the median relapse-free survival(RFS)was 742 and 265 d,respectively(P=0.0099),and the median overall survival(OS)was1042 and 557 d,respectively(P=0.0071).RFS and OS were therefore not inferior in the FNA+group.These data indicate that the use of EUS-FNA did not influence RFS or OS,nor did it increase the risk of peritoneal recurrence.CONCLUSION:In patients with resectable pancreatic cancer,preoperative EUS-FNA is a safe and accurate diagnostic method.     

细胞块结合免疫组化在内镜超声引导下穿刺诊断胰腺实性占位中的应用价值

目的探讨超声内镜引导下细针穿刺（EUS—FNA）物行不同细胞学检查方法对胰腺占位性病变的诊断价值。方法前瞻性研究广西医科大学第一附属医院2012年3月至2013年6月收治的胰腺实性占位性病变72例,均行超声内镜引导下细针穿刺活检取材,分别行常规涂片、液基涂片及细胞块结合免疫组化检查。结果72例患者中,最终确诊胰腺肿瘤61例,包括胰腺癌55例、胰腺假乳头状瘤2例、胰腺内分泌肿瘤4例;良性病变11例,包括慢性胰腺炎4例、胰腺结核2例、胰腺炎4例、黏液性囊腺瘤1例。常规涂片、液基涂片和细胞块结合免疫组化对胰腺肿瘤的诊断敏感度分别为68．9％（42／61）、75．4％（46／61）和90．2％（55／61）,特异度均为100．0％,准确率分别为73．6％（53／72）、79．2％（57／72）和91．7％（66／72）,细胞块结合免疫组化诊断准确率高于常规涂片细胞学及液基细胞学（P均〈0．05）。术后患者均无出血、感染、急性胰腺炎等并发症。结论EUS—FNA是一种安全有效的诊断胰腺占位病变的方法,具有高敏感度和特异度。EUS—FNA细胞块结合免疫组化有助于胰腺实性占位病变的定性诊断和组织学分型诊断,对治疗方案的选择有较大的临床应用价值。     

Concise review on the comparative efficacy of endoscopic ultrasound-guided fine-needle aspiration vs core biopsy in pancreatic masses,upper and lower gastrointestinal submucosal tumors

Endoscopic ultrasound(EUS)-guided fine needle aspiration with or without biopsy(FNA/FNB) are the primary diagnostic tools for gastrointestinal submucosal tumors. EUS-guided fine needle aspiration(EUS-FNA) is considered a first line diagnostic method for the characterization of pancreatic and upper gastrointestinal lesions, since it allows for the direct visualization of the collection of specimens for cytopathologic analysis. EUSFNA is most effective and accurate when immediate cytologic assessment is permitted by the presence of a cytopathologist on site. Unfortunately, the accuracy and thus the diagnostic yield of collected specimens suffer without this immediate analysis. Recently, a EUS-FNB needle capable of obtaining core samples(fine needle biopsy, FNB) has been developed and has shown promising results. This new tool adds a new dimension to the diagnostic and therapeutic utility of this technique. The aim of the present review is to compare the efficacy of EUS-FNA to that afforded by EUS-FNB in the characterization of pancreatic masses and of upper and lower gastrointestinal submucosal tumors.     

快速线上评估在胰腺实性病变内镜超声引导下细针抽吸术中的应用价值（含视频）

目的评价快速线上评估（rapid on-line evaluation,ROLE）在胰腺实性病变内镜超声引导下细针抽吸术（endoscopic ultrasonography-guided fine needle aspiration,EUS-FNA）临床诊断中的应用价值。方法回顾性分析2017年10月—2019年10月北京大学第一医院进行EUS-FNA的胰腺实性病变患者资料。根据是否进行ROLE法,分为ROLE组和对照组。ROLE组根据病理医师判断是否获得足量胰腺组织细胞或异型细胞来决定是否继续穿刺,对照组根据内镜医师穿刺经验判断是否获得足量肉眼组织条决定是否继续穿刺。EUS-FNA获得的标本由另一位病理医师给出细胞学和组织学诊断,而最终诊断的金标准基于手术切除标本的组织学诊断,对于没有接受手术治疗的患者,最终诊断依据临床病程、影像学、肿瘤标志物和治疗效果反馈等综合结果。比较两组的诊断率、准确率、灵敏度、特异度、穿刺针数、操作时间及并发症发生率等指标。结果共纳入87例患者,其中ROLE组51例,对照组36例。ROLE组诊断率高于对照组,但差异无统计学意义 [98.0%(50/51) 比 86.1%(31/36), P=0.078];ROLE组的穿刺针数少于对照组,差异有统计学意义（中位数2针比3针,P＜0.001）;ROLE组的操作时间与对照组相比,差异无统计学意义（均数19.4 min 比 18.5 min,P=0.089）,两组在诊断的准确率、灵敏度、特异度、阳性预测值、阴性预测值、并发症发生率上差异均无统计学意义（P＞0.05）。结论ROLE在胰腺实性病变EUS-FNA中能提高穿刺的组织获取量,减少穿刺针数,且不明显增加操作的时间和风险。     

Push vs pull method for endoscopic ultrasound-guided fine needle aspiration of pancreatic head lesions: Propensity score matching analysis

AIM To evaluate the efficacy of endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) of pancreatic head cancer when pushing(push method) or pulling the echoendoscope(pull method).METHODS Overall, 566 pancreatic cancer patients had their first EUS-FNA between February 2001 and December 2017. Among them, 201 who underwent EUS-FNA for pancreatic head lesions were included in this study. EUS-FNA was performed by the push method in 85 patients, the pull method in 101 patients and both the push and pull methods in 15 patients. After propensity score matching(age, sex, tumor diameter, and FNA needle), 85 patients each were stratified into the push and pull groups. Patient characteristics and EUSFNA-related factors were compared between the two groups.RESULTS Patient characteristics were not significantly different between the two groups. The distance to lesion was significantly longer in the push group than in the pull group(13.9 ± 4.9 mm vs 7.0 ± 4.9 mm, P 0.01). The push method was a significant factor influencing the distance to lesion(≥ median 10 mm)(P 0.01). Additionally, tumor diameter ≥ 25 mm(OR = 1.91, 95%CI: 1.02-3.58, P = 0.043) and the push method(OR = 1.91, 95%CI: 1.03-3.55, P = 0.04) were significant factors contributing to the histological diagnosis of malignancy.CONCLUSION The pull method shortened the distance between the endoscope and the lesion and facilitated EUS-FNA of pancreatic head cancer. The push method contributed to the histological diagnosis of pancreatic head cancer using EUS-FNA specimens.     

Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is effective for tissue diagnosis of pancreatic mass. To improve diagnostic yield and drawbacks, 22-gauge (G) core biopsy (FNB) needle has been developed. This study aims to compare 22G FNA and FNB needles for EUS-guided sampling of suspected pancreatic cancer.

Methods: This is a randomized controlled crossover trial. A total of 60 patients with suspected unresectable pancreatic cancer referred for EUS-guided sampling were randomly assigned to two groups. Both groups had 22G FNA and FNB needles performed in a randomized order. The primary endpoint was the cytological, histological and overall diagnostic accuracy of pancreatic cancer.

Results: FNA and FNB needles reported similar level of diagnostic accuracy (FNA needle 95% vs. FNB needle 93.3%; p?=?.564), and it was not statistically different. However, cytological cellularity was significantly higher in the FNB needles compared to FNA needles (odds ratio 2.75, 95% confidence interval (CI)). There were no procedure-related complications in both needles.

Conclusions: The diagnostic accuracy of EUS-guided sampling for pancreatic cancer using 22G FNA is comparable to FNB needles. The cytological quality of specimen is better in the FNB needle.     

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

AIM: To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fi ne-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. METHODS: From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUS-FNA. The fi nal diagnosis was obtained either by surgery (356 cases) or after a mean clinical follow-up of 11.8 mo in the remaining patients. RESULTS: There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 (97.4/) cases. There were 352 (57.6/) malignancies and 259 (42.4/) benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67/ of the lesions. Overall, the sensitivity, specifi city, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4/, 99.2/, 99.3/, 77.2/ and 87.2/. Specif ically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8/ vs 82.4/, 100/ vs 98.4/, 100/ vs 99/, 54.8/ vs 74.1/ and 83.1/ vs 87.8/. For cystic lesions, the values were, respectively, 72.2/, 99.3/, 97.5/, 91/ and 92.2/. CONCLUSION: EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions canreveal the best negative predictive value and diagnostic accuracy, both higher than 90/.     

Efficacy of endoscopic samplings during initial biliary drainage for cases of pancreatic head cancer: United diagnostic yields of multiple pathological samplings

Background/objectivesThe diagnostic ability of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been fully studied; however, the efficacy of other endoscopic samplings (OESs) is less clear. The aim of this study was to examine the diagnostic efficacies of OESs for pancreatic head cancer (PHC).MethodsThe diagnostic efficacies of endoscopic samplings were retrospectively analyzed in 448 PHC cases and 63 cases of mass-forming pancreatitis (MFP) during initial transpapillary biliary drainage. The OESs included duodenal biopsy (118 PHCs and 50 MFPs), biliary biopsy (218 and 51) with cytology (368 and 53), and pancreatic duct biopsy (23 and 13) with cytology (56 and 43). EUS-FNA was conducted in a different session (149 and 62). Factors associated with OES sensitivity were analyzed. The sensitivity of biliary biopsy was compared between 1.95 mm and 1.8 mm forceps.ResultsCancer cells were confirmed in 87.9% of the EUS-FNA samplings and in 64.1% (268/418) obtained by combined OESs (average 1.7 OES types per case): 68.6% by duodenal biopsy, 59.6% by biliary biopsy, 32.6% by biliary cytology, 73.9% by pancreatic duct biopsy, and 33.9% by pancreatic duct cytology. No MFP cases revealed cancer by any sampling. OESs did not increase adverse events. Duodenal stenosis, serum bilirubin, tumor size, and pancreatic juice amounts were associated with OES sensitivity. Biliary biopsy had the same sensitivity with different forceps.ConclusionEUS-FNA was the most diagnostic protocol; however, OESs can be safely applied during the initial biliary drainage to reduce the demand for EUS-FNA while providing good diagnostic yields.     

Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

BACKGROUND Establishing a diagnosis of pancreatic cystic lesions(PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound(EUS)-through-the-needle biopsy(EUS-TTNB) using microforceps in PCLs has been made available.AIM To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.METHODS We retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration(FNA) for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis.RESULTS A total of 56 patients(mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8 mm(12-85 mm). The EUS-TTNB procedure was technically successful in all patients(100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA,respectively 80.4%(45/56) vs 25%(14/56). Adverse events occurred in 2 patients(3.6%) who developed mild pancreatitis that resolved with medical therapy.Using TTNB specimens, 23 of 32 cases(71.9%) with intraductal papillary mucinous neoplasm were further differentiated into gastric type(19 patients) and pancreaticobiliary type(4 patients) based on immunochemical staining.CONCLUSION EUS-TTNB for PCLs was technically feasible and had a favorable safety profile.Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen. EUSTTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.     

Factors affecting the yield of endoscopic transpapillary bile duct biopsy for the diagnosis of pancreatic head cancer

BackgroundTranspapillary biliary biopsy (TBB) is a simple endoscopic technique that can be performed during an initial biliary drainage session. This procedure has the potential to reduce the load of another tissue sampling in cases of pancreatic head cancer (PHC) with biliary stricture. The aim of this study is to identify factors associated with a positive outcome using TBB for PHC.MethodsIn total, 130 cases that underwent TBB for investigation of distal biliary stricture were included [62 cases of PHC, 36 cases of distal biliary cancer (DBC), and 32 cases of benign biliary stricture (BBS)]. Factors affecting the diagnostic efficiency of TBB were determined using univariate and multivariate logistic analyses.ResultsCancer tissue was obtained in 31 cases (50%) of PHC and 33 cases (91.7%) of DBC. Multivariable analysis showed that ≧10 mg/dl of serum bilirubin level (odds ratio [OR]: 5.58; 95% confidence interval [CI]: 1.29–28.20; P = 0.021) and ≧3 tissue samplings (OR: 3.59; 95% CI: 1.02–14.27, P = 0.046) were independent factors affecting cancer-positive rate in cases of PHC. In >90% of resected cases of PHC, cancer involved the left side of the biliary mucosa and the range of cancer invasion (≧2/3 of circumference of biliary mucosa) was also a significant factor (P = 0.001).ConclusionsPHC showing high level of serum bilirubin (>10 mg/dl) and high circumferential proportion of bile duct invasion (>2/3 judging from MDCT) is a good indication for biliary biopsy. Targeting the left-side wall and ≧3 tissue samplings will lead to the higher sensitivity.