Background and Aims
For EUS-guided fine-needle biopsy sampling (EUS-FNB) of solid pancreatic lesions (SPLs),
the role of sampling strategy between targeted biopsy sampling and wide sampling has
not been reported. This study aimed to investigate the benefits of the 2 sampling
techniques on EUS-FNB using rapid on-site evaluation.
Methods
Patients with SPLs were prospectively enrolled and randomly assigned (1:1) to undergo
EUS-FNB using either contrast guidance or the fanning technique. The primary outcome
was the total number of passes required to establish a diagnosis, and secondary outcomes
were overall diagnostic accuracy and adverse event rates.
Results
One hundred eighteen patients were enrolled from February 2019 to January 2021, with
59 patients assigned to each group. There was no significant difference in the total
number of passes required to establish a diagnosis between the contrast and fanning
groups (median, 1 [interquartile range, 1-1] vs 1 [interquartile range, 1-2], respectively;
P = .629). The sensitivity, specificity, and diagnostic accuracy in the contrast group
was 100%, 66.7%, and 98.3% and in the fanning group 100%, 100%, and 100%, respectively
(P = 1). An SPL <4 cm (odds ratio, 2.47; 95% confidence interval, 1.05-5.81; P = .037) and macroscopic visible core length >1 cm (odds ratio, 2.89; 95% confidence
interval, 1.07-7.84; P = .037) were independently associated with increased cytologic and histologic accuracy.
Conclusions
The diagnostic accuracy of EUS-FNB with the fanning technique for SPLs was comparable
with the contrast guidance technique. Without additional cost, EUS-FNB with the fanning
technique may be preferred for SPLs. (Clinical trial registration number: NCT04924725.)
Abbreviations:
CEH-EUS (contrast-enhanced harmonic EUS), FNB (fine-needle biopsy sampling), IQR (interquartile range), MVC (macroscopic visible core), RCT (randomized controlled trial), ROSE (rapid on-site cytologist evaluation), SPL (solid pancreatic lesion)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- GBD 2017 Pancreatic Cancer Collaborators. The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet Gastroenterol Hepatol. 2019; 4: 934-947
- Endoscopic ultrasound (EUS) and the management of pancreatic cancer.BMJ Open Gastroenterol. 2020; 7 (e000408)
- Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline—updated January 2017.Endoscopy. 2017; 49: E695-E714
- The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia.Gastrointest Endosc. 2016; 83: 17-28
- Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis.Endoscopy. 2021; 53: E411-E423
- Endoscopic ultrasound-guided fine-needle biopsy with or without rapid on-site evaluation for diagnosis of solid pancreatic lesions: a randomized controlled non-inferiority trial.Gastroenterology. 2021; 161: 899-909
- Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia.Gastrointest Endosc. 2011; 74: 933-935
- Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions.Endoscopy. 2013; 45: E445-E450
- Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma.Gastrointest Endosc. 2018; 87: 158-163
- Conventional versus contrast-enhanced harmonic endoscopic ultrasonography-guided fine-needle aspiration for diagnosis of solid pancreatic lesions: a prospective randomized trial.Pancreatology. 2015; 15: 538-541
- Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration versus standard fine-needle aspiration in pancreatic masses: a meta-analysis.Expert Rev Gastroenterol Hepatol. 2021; 15: 1-8
- The Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) guidelines for contrast-enhanced endoscopic ultrasound.Ultrasound Med Biol. 2021; 47: 1433-1447
- Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) technical guideline—March 2017.Endoscopy. 2017; 49: E989-E1006
- Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study).Gastrointest Endosc. 2015; 81: 177-185
- Diagnostic ability of EUS-FNA for pancreatic solid lesions with conventional 22-gauge needle using the slow pull technique: a prospective study.Scand J Gastroenterol. 2015; 50: 900-907
- A lexicon for endoscopic adverse events: report of an ASGE workshop.Gastrointest Endosc. 2010; 71: 446-454
- Randomized trial comparing fork-tip and side-fenestrated needles for EUS-guided fine-needle biopsy of solid pancreatic lesions.Gastrointest Endosc. 2020; 92: 648-658
- Comparison of contrast-enhanced versus conventional EUS-guided FNA/fine-needle biopsy in diagnosis of solid pancreatic lesions: a randomized controlled trial.Gastrointest Endosc. 2021; 94: 303-310
- Comparative diagnostic accuracy of EUS needles in solid pancreatic masses: a network meta-analysis.Endosc Int Open. 2021; 9: E853-E862
- 22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy.Endoscopy. 2020; 52: E747-E753
- Macroscopic visible core length can predict the histological sample quantity in endoscopic ultrasound-guided tissue acquisition: multicenter prospective study.Dig Endosc. 2022; 34: 622-631
- Effect of pancreatic mass size on clinical outcomes of endoscopic ultrasound-guided fine-needle aspiration.Dig Dis Sci. 2019; 64: 2006-2013
Article info
Publication history
Published online: December 09, 2022
Accepted:
December 1,
2022
Received:
May 20,
2022
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
DIVERSITY, EQUITY, AND INCLUSION: The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy