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Multicenter Study
. 2024 May;36(5):615-624.
doi: 10.1111/den.14686. Epub 2023 Oct 25.

Repeated endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions after previous nondiagnostic or inconclusive sampling

Andrea Lisotti  1 , Anna Cominardi  1   2 , Maria Cristina Conti Bellocchi  3 , Stefano Francesco Crinò  3 , Alberto Larghi  4 , Antonio Facciorusso  5 , Paolo Giorgio Arcidiacono  6 , Claudio De Angelis  7 , Francesco Maria Di Matteo  8 , Carlo Fabbri  9 , Helga Bertani  10 , Thomas Togliani  11 , Gianenrico Rizzatti  4 , Mario Brancaccio  12 , Antonino Grillo  13 , Alberto Fantin  14 , Alessandro Pezzoli  15 , Francesca D'Errico  16 , Arnaldo Amato  17 , Filippo Antonini  18 , Amedeo Montale  19 , Antonio Pisani  20 , Edoardo Forti  21 , Mauro Manno  22 , Silvia Carrara  23 , Maria Chiara Petrone  6 , Cecilia Binda  9 , Rocco Maurizio Zagari  24   25 , Pietro Fusaroli  1 ; REUBIO Study Group
Collaborators, Affiliations
Multicenter Study

Repeated endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions after previous nondiagnostic or inconclusive sampling

Andrea Lisotti et al. Dig Endosc. 2024 May.

Abstract

Objectives: Repeated endoscopic ultrasound (EUS)-guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine-needle biopsy (rEUS-FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes.

Methods: Consecutive patients undergoing rEUS-FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6-month follow-up, and benign pathology together with ≥12-month follow-up were adopted as gold standards.

Results: Among 462 patients, 56.5% were male, with a median age of 68 (59-75) years, malignancy prevalence 77.0%. Tumor size was 26 (20-35) mm. Second-generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS-FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false-negative and 12 false-positive results). On multivariate analysis, rEUS-FNB performed at high-volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10-3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00-1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second-generation FNB needles (OR 5.42; 95% CI 2.30-12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31-7.06; P = 0.009) were independently related to sample adequacy.

Conclusion: Repeated EUS-FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high-volume centers improved diagnostic accuracy. The use of second-generation FNB needles significantly improved sample adequacy over standard EUS-FNB needles.

Keywords: fine needle aspiration; neuroendocrine neoplasm; pancreatic cancer; pancreatic ductal adenocarcinoma.

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Conflict of interest statement

Authors declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
Study flowchart. EUS, endoscopic ultrasound; EUS‐FNA, EUS fine‐needle aspiration; EUS‐FNB, EUS fine‐needle biopsy.
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