Background and Aims
EUS-guided through-the-needle biopsy sampling (EUS-TTNB) using microbiopsy forceps
is performed for the accurate diagnosis of pancreatic cystic lesions (PCLs). However,
there are no standardized protocols for this procedure, and the amount of data on
its efficacy is limited. Here, we evaluated the feasibility, efficacy, and safety
of EUS-TTNB in categorizing the types of PCLs and identified the factors associated
with diagnostic failure.
Methods
The prospectively collected and maintained EUS-TTNB database at Asan Medical Center
was reviewed to identify patients with PCLs who underwent EUS-TTNB between January
2019 and January 2021. The primary outcomes were technical success, diagnostic yield,
and adverse events. Factors contributing to diagnostic failure and the discrepancies
in the diagnosis made by conventional modalities (ie, EUS morphology, cross-sectional
imaging, and cystic fluid analysis) were also evaluated.
Results
Forty-five patients were analyzed. EUS-TTNB was successfully performed in all patients
(technical success, 100%). Histologic diagnosis of PCLs was made in 37 patients (diagnostic
yield, 82%). When comparing EUS-TTNB with a presumptive diagnosis, EUS-TTNB changed
the diagnosis in 10 patients in terms of the categorization of the types of PCLs.
The diagnostic yield was significantly higher in those who had 4 or more visible biopsy
specimens per session (93%) than in those with fewer than 4 visible biopsy specimens
per session (67%; P = .045). During follow-up, 3 patients (7%) experienced adverse events (2 acute pancreatitis,
1 intracystic bleeding), and no life-threatening adverse event occurred.
Conclusions
EUS-TTNB showed high technical feasibility, diagnostic yield, and good safety profile.
EUS-TTNB may improve the categorization of the types of PCLs. Studies with standardized
procedure protocols are needed to reduce the diagnostic failure for the types of PCLs.
Graphical abstract
Graphical Abstract
Abbreviations:
CEA (carcinoembryonic antigen), EUS-TTNB (endoscopic ultrasound-through-the-needle biopsy sampling), IPMN (intrapapillary mucinous neoplasm), MCN (mucinous cystic neoplasm), PCL (pancreatic cystic lesion)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 05, 2021
Accepted:
September 24,
2021
Received:
April 18,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
See CME section, p. 372.
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
