Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions

      Background and Aims

      EUS-guided through-the-needle biopsy (TTNB) sampling has been reported to improve diagnostic yield compared with cytology for the evaluation of pancreatic cystic lesions (PCLs). The number of macroscopically visible tissue samples needed to reach an adequate diagnosis is still unknown.


      This is a retrospective, single-center study on consecutive patients with PCLs with risk features (cyst >3 cm, thickened wall, cyst growth during follow-up, and mural nodules) who underwent TTNB sampling. The capability of differentiating mucinous versus nonmucinous cysts, ability to obtain a cyst-lining epithelium, definition of the grade of dysplasia, and specific diagnosis of cyst histotype were evaluated for 1, 2, or 3 TTNB macroscopically visible specimens.


      Sixty-one patients were evaluated. A 100% histologic adequacy was reached by 2 samples (P = .05 versus 1). Compared with cytology, 1 TTNB specimen improved the possibility of defining cyst histotype (P < .0001), whereas 2 specimens increased all 4 diagnostic categories (P < .003). Two specimens also increased diagnostic yield compared with 1 sample (P < .085). The collection of a third sample did not improve the value of any diagnostic categories. A specific diagnosis was reached in 74% of patients with 2 histologic samples. The diagnostic reliability of TTNB sampling compared with surgical histology was 90%, with a 22.9% rate of adverse events.


      Two TTNB macroscopically visible specimens reached 100% histologic adequacy and a specific diagnosis in 74% of patients. The collection of a third specimen did not add any additional information and should be avoided to possibly decrease the risk of adverse events.

      Graphical abstract


      AE (adverse event), CEA (carcinoembryonic antigen), MCN (mucinous cystic neoplasm), PCL (pancreatic cystic lesion), TTNB (through-the-needle biopsy)
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      Linked Article

      • Through-the-needle biopsy sampling may allow preoperative intraductal papillary mucinous neoplasia subtyping
        Gastrointestinal EndoscopyVol. 92Issue 1
        • Preview
          We read with great interest the study by Crinò et al1 regarding biopsy sampling of pancreatic cystic lesions (PCL). The investigators, besides establishing the number of samples needed to reach an adequate diagnosis using EUS-guided through-the-needle microforceps biopsy, make the first description that tries to standardize the diagnostic criteria for cystic lesions by use of through-the-needle biopsy (TTNB) specimens. To evaluate the diagnostic capabilities of TTNB sampling, the authors propose the assessment of 4 histologic criteria: (1) provide cyst-lining epithelium, (2) differentiate mucinous from nonmucinous cysts, (3) define the grade of dysplasia, and (4) provide a specific diagnosis of cyst histotype.
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        • PDF
      • Pancreatic cyst through-the-needle biopsy: two’s the charm
        Gastrointestinal EndoscopyVol. 90Issue 6
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          Pancreatic cystic lesions (PCLs) are commonly encountered, with a prevalence of over 40% in patients undergoing cross-sectional imaging; the incidence increases with age.1 The vast majority are discovered incidentally, are branch duct intraductal papillary mucinous neoplasms (IPMNs), and will never progress to cancer. Despite this, and because the guidelines are controversial and based on little evidence, the management of PCLs continues to create anxiety and frustration for both the patient and the gastroenterologist.
        • Full-Text
        • PDF