Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor

Abstract

Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030, a high mortality rate considering the number of cases. Surgery and chemotherapy are the main treatment options, but they are burdensome for patients. A clear histological diagnosis is needed to determine a treatment plan, and endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract seeding. With the development of personalized medicine and precision treatment, there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure, leading to the development of the fine-needle biopsy (FNB) needle. EUS-FNB is rapidly replacing EUS-guided fine-needle aspiration (FNA) as the procedure of choice for EUS-TA of pancreatic cancer. However, EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions, so it is important clinicians are familiar with both. Given these recent dev-elopments, we present an up-to-date review of the role of EUS-TA in pancreatic cancer. Particularly, technical aspects, such as needle caliber, negative pressure, and puncture methods, for obtaining an adequate specimen in EUS-TA are discussed.

Keywords: Endoscopic ultrasound-guided fine needle biopsy; Endoscopic ultrasound-guided tissue acquisition; Genomic profiling test; Pancreatic cancer; Personalized medicine; Puncture procedure.

Figure 1

Examples of needle designs. A: Menghini needle (EZ shot 3, Olympus medical systems, Tokyo, Japan); B: Reverse-beveled needle (ProCore, Cook Medical, Bloomington, IN, United States); C: Franseen needle (AcquireTM, Boston Scientific, Marlborough, MA, United States); D: Fork-tip needle (SharkCore, Medtronic, Minneapolis, MN, United States).