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. 2019 Nov 16;11(11):531-540.
doi: 10.4253/wjge.v11.i11.531.

Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

Rintaro Hashimoto  1 , John G Lee  2 , Kenneth J Chang  2 , Nabil El Hage Chehade  2 , Jason B Samarasena  2
Affiliations

Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

Rintaro Hashimoto et al. World J Gastrointest Endosc. .

Abstract

Background: Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps in PCLs has been made available.

Aim: To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.

Methods: We retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration (FNA) for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis.

Results: A total of 56 patients (mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8 mm (12-85 mm). The EUS-TTNB procedure was technically successful in all patients (100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA, respectively 80.4% (45/56) vs 25% (14/56). Adverse events occurred in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Using TTNB specimens, 23 of 32 cases (71.9%) with intraductal papillary mucinous neoplasm were further differentiated into gastric type (19 patients) and pancreaticobiliary type (4 patients) based on immunochemical staining.

Conclusion: EUS-TTNB for PCLs was technically feasible and had a favorable safety profile. Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen. EUS-TTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.

Keywords: Biopsy; Cyst fluid; Endoscopic ultrasound; Endoscopic ultrasound-guided fine needle aspiration; Pancreatic cyst lesion.

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Conflict of interest statement

Conflict-of-interest statement: No financial support was received from the company of microforceps to conduct this study. Dr Samarasena is a consultant to US Endoscopy. None of the other authors have any relevant conflicts of interest.

Figures

Figure 1
Figure 1
Image of MorayTM microforceps (US Endoscopy, OH, United States).
Figure 2
Figure 2
Endosonographic image of the microforceps opened within a pancreatic cystic lesion.
Figure 3
Figure 3
Endosonographic image of the microforceps bite of the wall tenting tissue within a pancreatic cystic lesion.
See this image and copyright information in PMC

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