Endoscopic ultrasound guided fine-needle biopsy versus endoscopic ultrasound guided fine-needle aspiration in the diagnosis of pancreatic and extrapancreatic solid lesions

Aims Endoscopic ultrasound guided fine-needle aspiration (EUS FNA) and endoscopic ultrasound guided fine-needle biopsy (EUS FNB) are the current standard for diagnosing pancreatic tumors, but recent studies have failed to show superiority of either tool. The aim of this study was to assess the sensitivity and diagnostic accuracy of EUS FNA and EUS FNB in diagnosis of pancreatic and extrapancreatic solid lesions in our cohort. Methods A retrospective study was conducted among 89 adult patients with pancreatic and extrapancreatic solid lesion visualized on abdominal computed tomography or magnetic resonance in the period from January 2022 and December 2022. Patients with a cystic lesion and/or a contraindication for aspiration or a biopsy of the lesion were excluded. Patients were divided in EUS FNA and EUS FNB group. Data of interest were basic patients and disease characteristics as well as cytology and pathohistology results of acquired samples. Samples were obtained with FNA (Olympus EZ shot 3Plus) or FNB (Boston scientific Acquire), using 22- or 19-gauge needles in two passes and low negative pressure via either transgastric or transduodenal approach. Macroscopic on-site evaluation (MOSE) was performed whenever possible on FNB samples. Results The majority of patients were male (57.3%) aged between 65-80 years of age (40.4%). Identified lesion were predominately localized in the head of the pancreas (46.1%). FNB was performed in 62 (69.7%) and FNA in 27 (30.3%) patients. Pathohistology sample was adequate in 30.6% patients, hence only cytopathology results were included. Tumor was not proven in 18 (20.2%) of patients. Among identified tumors, 67 (94.4%) were malignant, most commonly adenocarcinoma (57/67; 85%) followed by neuroendocrine tumor (6/67; 9%), gastrointestinal stromal tumor (2/67, 3%) and lymphomas (2/67, 3%). MOSE was performed in 23.6% patients in FNB group. In our cohort, FNB outperformed FNA in sensitivity (96.55%; 95% CI 88.09%-99.58% vs. 89.47%; 95% CI 66.86%-98.69%) and in diagnostic accuracy (93.55%; 95% CI 84.29%- 98.21% vs. 62.96%; 95% CI 42.36%-80.59%). Adverse event were rare. One episode of mild acute pancreatitis was noted in FNB group, while a prolonged hemorrhage which resolved spontaneously was noted in FNA group. [ 1 ] [ 2 ] [ 3 ] Conclusions In our cohort of patients, FNB was more sensitive and accurate in the diagnosis of solid pancreatic and extrapancreatic tumors than FNA. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany