EUS-guided Fine Needle Aspiration (EUS-FNA) with Rapid-On-Site-Evaluation (ROSE) vs Fine Needle Biopsy (EUS-FNB) for the Pathological Diagnosis of Solid Pancreatic Tumors: Analysis of a Prospective EUS Registry

Aims to evaluate the accuracy of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) with rapid on-site evaluation (ROSE) and EUS-guided fine needle biopsy (FNB) without ROSE for the diagnosis of solid pancreatic tumors (SPT).

Methods The study identified patients from a prospective EUS registry who underwent EUS-guided sampling for SPT evaluation between 2016 and 2023 using either EUS-FNA with ROSE or EUS-FNB. The EUS procedures were performed using linear Pentax or Fujifilm echoendoscopes and Hitachi systems. Cytological and core needles of 25-gauge or 22-gauge were used for EUS-FNA and EUS-FNB, respectively. The presented data includes the mean, standard deviation, and percentages. Student's t-test was used to compare continuous variables. The study analyzed diagnostic accuracy using either histopathological analysis of surgical specimens or clinical and radiological evaluation with a minimum follow-up of 6 months in non-operated patients as the reference method. The diagnostic accuracy of both strategies was compared using the χ² test.

Results A total of 566 patients were included in the study, with a mean age of 68.4±10.9 years. Of these, 294 (51.9%) were male. The size of SPT was 33.1±13.8 mm. Of the 566 tumors analyzed, 296 (52.3%) were located in the head of the pancreas, 198 (35%) in the body, 47 (8.3%) in the tail, and 25 (4.4%) in the uncinate process. EUS-FNA with ROSE was performed in 179 (31.6%) cases. The number of needle passes was 2.0±1.1 with cytology needles and 1.7±0.7 with core needles (p<0.001). Of the lesions, 497 (87.8%) were malignant and 69 (12.2%) were benign. Diagnostic sensitivity (97% vs 94.6%), specificity (100% vs 100%) and overall accuracy (97.2% vs 95.3%) were similar after EUS-FNA with ROSE and EUS-FNB, respectively (p=0.298).

Conclusions EUS-FNB with core needles demonstrated comparable diagnostic accuracy to EUS-FNA with ROSE for the cytohistological diagnosis of solid pancreatic tumors, while requiring fewer passes

Publication History

Article published online:
27 March 2025