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Randomized trial of contrast-enhanced harmonic guidance versus fanning technique for EUS-guided fine-needle biopsy of solid pancreatic lesions

  • Yu-Ting Kuo
    Affiliations
    Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Yu-Long Chu
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Weng-Fai Wong
    Affiliations
    Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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  • Ming-Lun Han
    Affiliations
    Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Chieh-Chang Chen
    Affiliations
    Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • I-Shiow Jan
    Affiliations
    Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Department of Laboratory Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Wern-Cherng Cheng
    Affiliations
    Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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  • Chia-Tung Shun
    Affiliations
    Department of Pathology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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  • Ming-Chang Tsai
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

    School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Tsu-Yao Cheng
    Affiliations
    Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Department of Laboratory Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Hsiu-Po Wang
    Correspondence
    Corresponding author: Hsiu-Po Wang, Professor Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine. No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. Telephone: 886-2-23123456 ext. 63658.
    Affiliations
    Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Published:December 09, 2022DOI:https://doi.org/10.1016/j.gie.2022.12.004
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      Abstract

      Background and Aims

      For EUS-guided fine-needle biopsy (EUS-FNB) of solid pancreatic lesions (SPLs), the role of sampling strategy between a targeted biopsy and wide sampling has not been reported. This study aimed to investigate the benefits of the two sampling techniques on EUS-FNB with 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 the secondary outcomes were overall diagnostic accuracy and complication rates.

      Results

      A total of 118 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 [1–2]; P = .629). The sensitivity, specificity, and diagnostic accuracy in the contrast and fanning groups were 100%, 66.7%, and 98.3%, versus 100%, 100%, and 100%, respectively (P = 1). An SPL size < 4 cm (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.05-5.81; P = .037) and macroscopic visible core length > 1 cm (OR, 2.89; 95% CI, 1.07-7.84; P = .037) were independently associated with increased cytologic and histologic accuracy.

      Conclusion

      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.

      Acronyms and abbreviations:

      CEH-EUS (contrast-enhanced harmonic endoscopic ultrasound), CI (confidence interval), EUS (endoscopic ultrasound), FNA (fine needle aspiration), FNB (fine needle biopsy), IQR (interquartile range), MOSE (macroscopic on-site evaluation), MVC (macroscopic visible core), OR (odds ratio), PDAC (pancreatic ductal adenocarcinoma), RCT (randomized controlled trial), ROSE (rapid on-site cytologist evaluation), SD (standard deviation), SPL (solid pancreatic lesion)
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