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CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1813041
Original Article

Endoscopic Ultrasound-Guided Tissue Acquisition in Solid Pancreatic Lesions: Fine Needle Aspiration or Fine Needle Biopsy—A Randomized Pilot Study from a Low-Resource Tertiary Care Center

Authors

  • Hemanta Kumar Nayak

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Shubham Gupta

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Mansi Chaudhary

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Kamlesh Ahari

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Saswati Kar

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Susama Patra

    2   Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Pritinanda Mishra

    2   Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Ajay Ghosh R.U

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Bramhadatta Pattnaik

    3   Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Ranjan Kumar Patel

    4   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Manas K. Panigrahi 

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

  • Subash Chandra Samal

    1   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Funding None.
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Abstract

Background

Solid pancreatic mass lesions pose a substantial diagnostic challenge, especially in resource-limited settings. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and fine-needle biopsy (EUS-FNB) are both widely utilized, yet comparative data on their performance under constrained conditions remain limited.

Materials and Methods

In this prospective, randomized, single-center pilot study, patients with suspected solid pancreatic lesions were randomized to undergo either EUS-FNA (n = 20) or EUS-FNB (n = 21). Diagnostic accuracy, sensitivity, specificity, sample cellularity, technical success, adverse events, and total cost (needle + pathological processing) were assessed.

Results

Forty-one patients were randomized. Diagnostic accuracy was slightly higher in the FNB group (95.2%) compared to the FNA group (90%). Sensitivity was similar for FNB (92.9%) and FNA (92.3%), but specificity was greater with FNB (100% vs. 85.7%). Technical success was 100% in both arms, with only minor adverse events reported. Most samples demonstrated moderate to high cellularity in both arms. The estimated cost per procedure was INR 22,200 for FNA and INR 27,400 for FNB.

Conclusion

EUS-FNB demonstrated slightly improved diagnostic yield but was expensive compared to FNA. In resource-limited settings, EUS-FNA offers a cost-effective and reliable first-line diagnostic option. Larger multicenter studies are needed to guide context-appropriate needle selection strategies.

Keywords

endoscopic ultrasound - fine-needle aspiration (FNA) - fine-needle biopsy (FNB) - adenocarcinoma - pancreatic cancer

Authors' Contributions

H.K.N.: substantial contribution to the conception and design of the study; read, edited, and approved the final manuscript; performed EUS-guided intervention.

S.G., M.C., K.A., S.K., and A.K.G.: substantial contribution to data collection and writing the first draft of the manuscript.

B.P. and R.K.P.: substantial contribution for statistical analysis, extensively edited the manuscript, and revised it critically for important intellectual content.

S.P. and P.M.: pathological reporting.

M.K.P. and S.C.S.: intellectual input and approval of the final manuscript.

All authors read the final manuscript and approved the manuscript.


Patients' Consent

Written informed consent was obtained from all the participating patients.

IEC clearance taken: IEC/AIIMS BBSR/PG Thesis/2022-23/42.

CTRI registration number: CTRI/2022/11/047481.




Publication History

Article published online:
18 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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