Rapid on-site evaluation reduces needle passes in endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions: a risk-benefit analysis

Abstract

Background: The effectiveness of endoscopic ultrasound-guided fine-needle aspiration increases with the number of needle passes but needle passes are also associated with increased risk of adverse events. The trade-off between needle passes and adequacy has not been well-characterized.

Aims: The purpose of this study was to compare the risk-benefit tradeoff of different sampling protocols with and without rapid onsite evaluation (ROSE).

Patients and methods: We used a discrete-event simulation model to compare eight different sampling protocols. Each sampling protocol was simulated 10,000 times to obtain the average performance for each scenario. The per-pass adequacy rates, ROSE, accuracy of the assessor and sampling limits were varied to determine the impact of these factors on the number of needle passes and adequacy rates.

Results: Increasing per-class adequacy can be achieved at a cost of increased needle passes. Sampling with ROSE achieved higher adequacy with fewer needle passes than policies using a fixed number of needle passes without ROSE.

Conclusions: Variable sampling policies using ROSE generally achieve greater per-case adequacy with fewer needle passes than non-ROSE sampling policies using a fixed number of passes.