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Original article Clinical endoscopy| Volume 97, ISSUE 4, P732-740, April 2023

Randomized trial of contrast-enhanced harmonic guidance versus fanning technique for EUS-guided fine-needle biopsy sampling 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 Hospital, 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
    Reprint requests: Hsiu-Po Wang, MD, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan.
    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

      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)
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