CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E242-E248
DOI: 10.1055/s-0043-124078
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Prospective evaluation of EUS-guided fine needle biopsy in pancreatic mass lesions

M. H. Larsen
1   Odense Pancreas Center (OPAC), Department of Surgery, Odense University Hospital, Odense C, Denmark
,
C. W. Fristrup
1   Odense Pancreas Center (OPAC), Department of Surgery, Odense University Hospital, Odense C, Denmark
,
S. Detlefsen
2   Odense Pancreas Center (OPAC), Department of Pathology, Odense University Hospital, Odense C, Denmark
,
M. B. Mortensen
1   Odense Pancreas Center (OPAC), Department of Surgery, Odense University Hospital, Odense C, Denmark
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Weitere Informationen

Publikationsverlauf

submitted 02. Juli 2017

accepted after revision 20. Oktober 2017

Publikationsdatum:
07. Februar 2018 (online)

Abstract

Background and study aim Due to the scarcity of specific data on endoscopic ultrasound (EUS)-guided fine-needle biopsies (SharkCore) FNB in the evaluation of pancreatic lesions, we performed a prospective study of the diagnostic performance of EUS SharkCore FNB in patients with pancreatic lesions. The aim of this study was to evaluate the diagnostic accuracy.

Patients and methods Single-center prospective study of 41 consecutive patients referred for EUS-FNB from October 2015 to April 2016 at our center. EUS-FNB was obtained in a predefined setting regarding the procedure and pathological evaluation. Data regarding demographics, lesion, technical parameters, and diagnostic accuracy were obtained.

Results The study included 41 consecutive patients (22 males (54 %); median age 68 years). The average size of the lesions was 28 mm (median: 30 mm). A diagnostic specimen was identified in 40 (98 %) cases during microscopy with an average of 2.4 passes. The route was trans-duodenal in 20 cases (49 %). The histological diagnosis of the specimens was malignant in 29 cases (71 %), benign in 8 (20 %), suspicious in 2 (5 %), atypical in 1 (2 %) and in 1 (2 %) no material for microscopic evaluation was obtained. This led to a diagnostic accuracy of 93 %, sensitivity of 91 % and a specificity of 100 %. 2 cases (5 %) of self-limiting bleeding were observed. The diagnosis at follow up was malignant in 32 (78 %) of the patients.

Conclusions EUS-FNB of pancreatic mass lesions with the SharkCore needle produced specimens with a diagnostic accuracy of 93 %. The procedure was safe and easy to perform, and these data support the use of EUS-FNB in a routine setting.

 
  • References

  • 1 Storm AC, Lee LS. Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?. World J Gastroenterol 2016; 22: 8658-8669
  • 2 Nelsen EM, Buhler D, Soni AV. et al. Endoscopic ultrasound in the evaluation of pancreatic neoplasms-solid and cystic: A review. World J Gastrointest Endosc 2015; 7: 318-327
  • 3 Iglesias-Garcia J, Larino-Noia J, Abdulkader I. et al. Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses. World J Gastroenterol 2014; 20: 9451-9457
  • 4 Ecka RS, Sharma M. Rapid on-site evaluation of EUS-FNA by cytopathologist: an experience of a tertiary hospital. Diagn Cytopathol 2013; 41: 1075-1080
  • 5 Khan MA, Grimm IS, Ali R. et al. A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment. Endosc Int Open 2017; 5: E363-E375
  • 6 Bhutani M, Koduru P, Lanke G. et al. The emerging role of endoscopic ultrasound-guided core biopsy for the evaluation of solid pancreatic masses. Minerva Gastroenterol Dietol 2015; 61: 51-59
  • 7 Brais RJ, Davies SE, O'Donovan M. et al. Direct histological processing of EUS biopsies enables rapid molecular biomarker analysis for interventional pancreatic cancer trials. Pancreatology 2012; 12: 8-15
  • 8 Christensen L, Mortensen MB, Detlefsen S. Breast Carcinoma With Unrecognized Neuroendocrine Differentiation Metastasizing to the Pancreas: A Potential Diagnostic Pitfall. Int J Surg Pathol 2016; 24: 463-467
  • 9 Cheng B, Zhang Y, Chen Q. et al. Analysis of Fine-Needle Biopsy Versus Fine-Needle Aspiration in Diagnosis of Pancreatic and Abdominal Masses: A Prospective, Multicenter, Randomized Controlled Trial. Clin Gastroenterol Hepatol 2017; DOI: 10.1016/j.cgh.2017.07.010.
  • 10 Iglesias-Garcia J, Poley J, Larghi A. et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
  • 11 Levy MJ, Jondal ML, Clain J. et al. Preliminary experience with an EUS-guided trucut biopsy needle compared with EUS-guided FNA. Gastrointest Endosc 2003; 57: 101-106
  • 12 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48: 339-349
  • 13 DiMaio CJ, Kolb JM, Benias PC. et al. Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study. Endosc Int Open 2016; 4: E974-E979
  • 14 Kandel P, Tranesh G, Nassar A. et al. EUS-guided fine needle biopsy sampling using a novel fork-tip needle: a case-control study. Gastrointest Endosc 2016; 84: 1034-1039
  • 15 Mortensen MB, Pless T, Durup J. et al. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy 2001; 33: 478-483
  • 16 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
  • 17 Puli SR, Bechtold ML, Buxbaum JL. et al. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: A meta-analysis and systematic review. Pancreas 2013; 42: 20-26
  • 18 Shahidi N, Ou G, Lam E. et al. When trainees reach competency in performing endoscopic ultrasound: a systematic review. Endosc Int Open 2017; 5: E239-E243
  • 19 Jhala NC, Grimm IS, Ali B. et al. Providing on-site diagnosis of malignancy on endoscopic-ultrasound-guided fine-needle aspirates: should it be done?. Ann Diagn Pathol 2007; 11: 176-181
  • 20 Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000; 51: 184-190
  • 21 Virk RK, Gamez R, Mehrotra S. et al. Variation of cytopathologistsʼ use of the indeterminate diagnostic categories “atypical” and “suspicious for malignancy” in the cytologic diagnosis of solid pancreatic lesions on endoscopic ultrasound-guided fine-needle aspirates. Diagn Cytopathol 2017; 45: 3-13
  • 22 Binmoeller KF, Thul R, Rathod V. et al. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc 1998; 47: 121-127
  • 23 Sakamoto H, Kitano M, Komaki T. et al. Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol 2009; 24: 384-390
  • 24 Gerke H, Rizk MK, Vanderheyden AD. et al. Randomized study comparing endoscopic ultrasound-guided Trucut biopsy and fine needle aspiration with high suction. Cytopathology 2010; 21: 44-51
  • 25 Jovani M, Abidi WM, Lee LS. Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study. Scand J Gastroenterol 2017; 52: 784-787
  • 26 Othman MO, Abdelfatah MM, Padilla O. et al. The cellularity yield of 3 different 22-gauge endoscopic ultrasound fine needle aspiration needles. Diagn Cytopathol 2017; 45: 426-432
  • 27 Ainsworth AP, Hansen T, Fristrup CW. et al. Indications for and clinical impact of repeat endoscopic ultrasound. Scand J Gastroenterol 2010; 45: 477-482
  • 28 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
  • 29 Wang KX, Ben QW, Jin ZD. et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290