The factors that influence the diagnostic accuracy and sample adequacy of EUS-guided tissue acquisition for the diagnosis of solid pancreatic lesions

ABSTRACT Background and Objectives EUS-guided tissue acquisition (EUS-TA) is the preferred method to acquire pancreatic cancer (PC) tissues. The factors associated with false-negative outcomes and inadequate samples should be explored to gain an understanding of EUS-TA. Methods The patients who underwent EUS-TA for suspected solid PC but whose results were false-negative were analyzed. The PC patients who underwent EUS-TA with true-positive results on the first day of every month during the study period were selected as the control group. The factors influencing diagnostic accuracy and sample adequacy were explored. Results From November 2017 to January 2022, 184 patients were included in the false-negative group, and 175 patients were included in the control group. Multivariate logistic regression demonstrated that the recent acute pancreatitis [odds ratio (OR): 0.478, 95% confidence interval (CI): 0.250–0.914, P = 0.026] and high echo component within the tumor (OR: 0.103, 95% CI: 0.027–0.400, P = 0.001) were independently associated with false-negative EUS-TA results. Meanwhile, using fine-needle biopsy (FNB) needles (OR: 2.270, 95% CI: 1.277–4.035, P = 0.005), more needle passes (OR: 1.651,95% CI: 1.239–2.199, P = 0.005), large tumor size (OR: 1.053, 95% CI: 1.029–1.077, P < 0.001), and high CA-19-9 level (OR: 1.001, 95% CI: 1.000–1.001, P = 0.019) were independently associated with true-positive EUS-TA outcomes. Three needle passes are needed to achieve optimal EUS-TA outcomes. Tumor location in the body/tail (OR: 1.38, 95% CI: 1.01–1.72; P = 0.04), needle passes ≥3 (OR: 1.90; 95% CI: 1.22–2.56; P < 0.001), and using the FNB needle (OR: 2.10; 95%: 1.48–2.85; P < 0.001) were independently related to sample adequacy. Conclusion Numerous factors were identified to be associated with the diagnostic accuracy and sample adequacy of EUS-TA.