Through-the-needle forceps biopsy for pancreatic cystic lesions: multiple meta-analyses but limited prospective data

With the mounting quality and utilization of cross-sectional imaging, pancreatic cystic lesions (PCLs) increasingly are being identified, particularly in asymptomatic and elderly patients. However, accurate classification among the various PCLs remains a persistent clinical challenge with the current standard-of-care diagnostic tools, consisting of endoscopic ultrasound (EUS), fine-needle aspiration (FNA), cyst fluid analysis (CEA), and cytology. While the primary challenge is in accurate differentiation of mucinous from non-mucinous PCLs, precise identification of mucinous PCLs with advanced neoplasia (high-grade dysplasia and/or adenocarcinoma) is also difficult. There have thus been several guidelines for management of pancreas cysts, but these still result in modest diagnostic accuracy. In fact, EUS-FNA has a sensitivity of at most 63 % for malignant PCLs with inadequate specimens in up to two-thirds of cases. Given these findings, up to 30 % of PCLs are incorrectly diagnosed as mucinous cysts, resulting in a large number of unnecessary surgical resections with postoperative morbidity approaching 40 % [1]. Improved accuracy in classifying PCLs, therefore, would reduce unwarranted pancreatic surgeries and associated complications, and save costs on unwarranted follow-up. Because of this, enormous effort has been put into development and evaluation of novel diagnostic modalities for PCLs, including cyst fluid molecular analysis, confocal laser endomicroscopy (CLE), and through-the-(EUS) needle microforceps.

Publication History

Article published online:
31 August 2020

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