Tissue acquisition and pancreatic masses: Which needle and which acquisition technique should be used?

Abstract

Background and study aims Pancreatic cancer represents the fourth most common cause of cancer-related deaths in Western countries and the need of a low-risk investigation to obtain an accurate histopathological diagnosis has become increasingly pressing. Endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA) is the standard method for obtaining samples from pancreatic masses. In recent years, there has been an increasing need to obtain histological specimens during EUS procedures, rather than cytological ones, to guide oncological treatment options, leading to the so-call “FNB concept.” Different needles have been developed for fine-needle biopsy (FNB) in recent years, enabling acquisition of larger specimens on which to perform histological and molecular analyses. The aim of this narrative review was to assess the role of EUS-guided FNA and FNB in patients with pancreatic masses, and to identify which needle and which acquisition technique should be used to improve tissue acquisition.

Publication History

Received: 01 April 2020

Accepted: 17 June 2020

Article published online:
22 September 2020

• References

• 1 Maitra A, Hruban RH. Pancreatic cancer. Annu Rev Pathol 2008; 3: 157-188
• 2 Cui X, Zhang Y, Yang J. et al. ZIP4 confers resistance to zinc deficiency-induced apoptosis in pancreatic cancer. Cell Cycle 2014; 13: 1180-1186
• 3 Pietryga JA, Morgan DE. Imaging preoperatively for pancreatic adenocarcinoma. J Gastrointest Oncol 2015; 6: 343-357
• 4 Del Chiaro M, Segersvard R, Lohr M. et al. Early detection and prevention of pancreatic cancer: is it really possible today?. World J Gastroenterol 2014; 20: 12118-12131
• 5 Ngamruengphong S, Li F, Zhou Y. et al. EUS and survival in patients with pancreatic cancer: a population-based study. Gastrointest Endosc 2010; 72: 78-83
• 6 Othman MO, Wallace MB. The role of endoscopic ultrasonography in the diagnosis and management of pancreatic cancer. Gastroenterol Clin North Am 2012; 41: 179-188
• 7 Kappelle WFW, Van Leerdam ME, Schwartz MP. et al. Rapid on-site evaluation during endoscopic ultrasound-guided fine-needle aspiration of lymph nodes does not increase diagnostic yield: A randomized, multicenter trial. Am J Gastroenterol 2018; 113: 677-685
• 8 Fabbri C, Fuccio L, Fornelli A. et al. The presence of rapid on-site evaluation did not increase the adequacy and diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions with core needle. Surg Endosc 2017; 31: 225-230
• 9 Lisotti A, Frazzoni L, Fuccio L. et al. Repeated EUS-FNA of pancreatic masses after nondiagnostic or inconclusive results: systematic review and meta-analysis. Gastrointest Endosc 2020; 91: 1234-1241.e4
• 10 Mizuno N, Bhatia V, Hosoda W. et al. Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA. J Gastroenterol 2009; 44: 742-750
• 11 Tian L, Tang AL, Zhang L. et al. Evaluation of 22G fine-needle aspiration (FNA) versus fine-needle biopsy (FNB) for endoscopic ultrasound-guided sampling of pancreatic lesions: a prospective comparison study. Surg Endosc 2018; 32: 3533-3539
• 12 Asokkumar R, Yung Ka C, Loh T. et al. Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a randomized study. Endosc Int Open 2019; 7: E955-E963
• 13 Bang JY, Kirtane S, Krall K. et al. In memoriam: Fine-needle aspiration, birth: Fine-needle biopsy: The changing trend in endoscopic ultrasound-guided tissue acquisition. Dig Endosc 2019; 31: 197-202
• 14 Ishigaki K, Nakai Y, Oyama H. et al. Endoscopic ultrasound-guided tissue acquisition by 22-Gauge Franseen and standard needles for solid pancreatic lesions. Gut Liver 2020; [Epub ahead of print]
• 15 Oppong KW, Bekkali NLH, Leeds JS. et al. Fork-tip needle biopsy versus fine-needle aspiration in endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized crossover study. Endoscopy 2020; 52: 454-461
• 16 Conti CB, Cereatti F, Grassia R. Endoscopic ultrasound-guided sampling of solid pancreatic masses: the fine needle aspiration or fine needle biopsy dilemma. Is the best needle yet to come?. World J Gastrointest Endosc 2019; 11: 454-471
• 17 Robles-Medranda C, Oleas R, Valero M. et al. Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial. Endoscopy 2020; 52: 268-275
• 18 James TW, Baron TH. A comprehensive review of endoscopic ultrasound core biopsy needles. Expert Rev Med Devices 2018; 15: 127-135
• 19 Facciorusso A, Wani S, Triantafyllou K. et al. Comparative accuracy of needle sizes and designs for EUS tissue sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc 2019; 90: 893-903
• 20 Cho E, Park CH, Kim TH. et al. A prospective, randomized, multicenter clinical trial comparing 25-gauge and 20-gauge biopsy needles for endoscopic ultrasound-guided sampling of solid pancreatic lesions. Surg Endosc 2020; 34: 1310-1317
• 21 Karsenti D, Tharsis G, Zeitoun JD. et al. Comparison of 20-gauge Procore® and 22-gauge Acquire® needles for EUS-FNB of solid pancreatic masses: an observational study. Scand J Gastroenterol 2019; 54: 499-505
• 22 Crinò SF, Manfrin E, Scarpa A. et al. EUS-FNB with or without on-site evaluation for the diagnosis of solid pancreatic lesions (FROSENOR): Protocol for a multicenter randomized non-inferiority trial. Dig Liver Dis 2019; 51: 901-906
• 23 Iwashita T, Yasuda I, Mukai T. et al. 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
• 24 Han P, Che D, Pallav K. et al. Models of the cutting edge geometry of medical needles with applications to needle design. Int J Mech Sci 2012; 65: 157-67
• 25 Leung Ki EL, Lemaistre AI, Fumex F. et al. Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation. Endosc Int Open 2019; 7: E189-E194
• 26 Varadarajulu S, Fockens P, Hawes RH. Best practices in endoscopic ultrasound-guided fine-needle aspiration. Clin Gastroenterol Hepatol 2012; 10: 697-703
• 27 Bang JY, Hebert-Magee S, Trevino J. et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic masses. Gastrointest Endosc 2012; 76: 321-327
• 28 Tadic M, Stoos-Veic T, Kusec R. Endoscopic ultrasound guided fine needle aspiration and useful ancillary methods. World J Gastroenterol 2014; 20: 14292-14300
• 29 Wani S. Basic techniques in endoscopic ultrasound-guided fine-needle aspiration: role of a stylet and suction. Endosc Ultrasound 2014; 3: 17-21
• 30 Kudo T, Kawakami H, Hayashi T. et al. High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2014; 80: 1030-1037
• 31 Nakai Y, Isayama H, Chang KJ. et al. Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses. Dig Dis Sci 2014; 59: 1578-1585
• 32 Matsubayashi H, Matsui T, Yabuuchi Y. et al. Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis. World J Gastroenterol 2016; 22: 628-640
• 33 Chen JY, Ding QY, Lv Y. et al. Slow-pull and different conventional suction techniques in endoscopic ultrasound- guided fine-needle aspiration of pancreatic solid lesions using 22-gauge needles. World J Gastroenterol 2016; 22: 8790-8797
• 34 Wang J, Wu X, Yin P. et al. Comparing endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) versus fine needle biopsy (FNB) in the diagnosis of solid lesions: study protocol for a randomized controlled trial. Trials 2016; 17: 198
• 35 Kin T, Katanuma A, Yane K. et al. 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
• 36 Sahai AV, Paquin SC, Gariepy G. A prospective comparison of endoscopic ultrasound-guided fine needle aspiration results obtained in the same lesion, with and without the needle stylet. Endoscopy 2010; 42: 900-903
• 37 Lee KY, Cho HD, Hwangbo Y. et al. Efficacy of 3 fine-needle biopsy techniques for suspected pancreatic malignancies in the absence of an on-site cytopathologist. Gastrointest Endosc 2019; 89: 825-831
• 38 Villa NA, Berzosa M, Wallace MB. et al. Endoscopic ultrasound-guided fine needle aspiration: The wet suction technique. Endosc Ultrasound 2016; 5: 17-20
• 39 Attam R, Arain MA, Bloechl SJ. et al. “Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc 2015; 81: 1401-1407
• 40 Bang JY, Magee SH, Ramesh J. et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-450
• 41 Park SW, Lee SS, Song TJ. et al. The diagnostic performance of novel torque technique for endoscopic ultrasound-guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial. Gastroenterol Hepatol 2020; 35: 508-515