Top

Published in:

29-10-2021 | Ultrasound | Original Article

Performance of EUS-FNB in solid pancreatic masses: a lesson from 463 consecutive procedures and a practical nomogram

Authors: Nico Pagano, Claudio Ricci, Carlo Ingaldi, Sinan Sadalla, Andrea Fabbri, Laura Alberici, Giovanna Impellizeri, Socrate Pallio, Rocco Maurizio Zagari, Antonio De Leo, Matteo Cescon, Riccardo Casadei

Published in: Updates in Surgery | Issue 3/2022

Abstract

The study’s main goal was the diagnostic adequacy of pancreatic endoscopic ultrasonographic (EUS) fine-needle biopsy (FNB) and associated predictive factors. The secondary objective was to define the diagnostic accuracy of EUS-FNB in the diagnosis of pancreatic masses and pancreatic malignancies. None of the studies reported the diagnostic adequacy and accuracy of EUS. We retrospectively identified patients with solid pancreatic lesions that underwent EUS-FNB between 2013, and 2018. We calculated diagnostic adequacy and related factors. Using definitive histology on the surgically resected specimen as the gold standard, we calculated diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNB. We identified a total of 463 procedures. Diagnostic specimens were adequate in 436 procedures (94.1%), while 27 biopsies provided insufficient samples (5.9%). The multivariate analysis showed that lesion size and needle caliper were the only factors influencing diagnostic adequacy. The use of a biopsy needle (OR 0.69, 95% CI 0.30–0.1.63, P 0.400) did not improve sample adequacy. We calculated sensitivity (100%), specificity (93.2%), diagnostic accuracy (93.2%), positive predictive value (97.1%), and negative predictive value (100%) using resected specimen as the gold standard. We found no significant complications. EUS-FNB is a reliable technique for the histological characterization of solid pancreatic masses.

Available only for authorised users

Basturk O, Hong S-M, Wood LD et al (2015) A revised classification system and recommendations from the baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol 39:1730–1741. https://doi.org/10.1097/PAS.0000000000000533CrossRefPubMedPubMedCentral

Sheth SG, Conwell DL, Whitcomb DC et al (2017) Academic pancreas centers of excellence: guidance from a multidisciplinary chronic pancreatitis working group at PancreasFest. Pancreatology 17:419–430. https://doi.org/10.1016/j.pan.2017.02.015CrossRefPubMed

Chari ST, Smyrk TC, Levy MJ et al (2006) Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 4:1010–1016. https://doi.org/10.1016/j.cgh.2006.05.017CrossRef

Dumonceau J-M, Deprez P, Jenssen C et al (2017) Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline—updated January 2017. Endoscopy 49:695–714. https://doi.org/10.1055/s-0043-109021CrossRefPubMed

Adler DG, Muthusamy VR, Ehrlich DS et al (2019) A multicenter evaluation of a new EUS core biopsy needle: experience in 200 patients. Endosc Ultrasound 8:99–104. https://doi.org/10.4103/eus.eus_53_17CrossRefPubMed

Fuccio L, Larghi A (2014) Endoscopic ultrasound-guided fine needle aspiration: how to obtain a core biopsy? Endosc Ultrasound 3:71–81. https://doi.org/10.4103/2303-9027.123011CrossRefPubMedPubMedCentral

Veitch A, Vanbiervliet G, Gershlick A et al (2016) Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy 48:385–402. https://doi.org/10.1055/s-0042-102652CrossRefPubMed

Acosta RD, Abraham NS, Chandrasekhara V et al (2016) The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc 83:3–16. https://doi.org/10.1016/j.gie.2015.09.035CrossRefPubMed

Polkowski M, Jenssen C, Kaye P et al (2017) Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) technical guideline—March 2017. Endoscopy 49:989–1006. https://doi.org/10.1055/s-0043-119219CrossRefPubMed

10.

Khashab MA, Chithadi KV, Acosta RD et al (2015) Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 81:81–89. https://doi.org/10.1016/j.gie.2014.08.008CrossRefPubMed

11.

Shah JN, Ahmad NA, Beilstein MC et al (2004) Clinical impact of endoscopic ultrasonography on the management of malignancies. Clin Gastroenterol Hepatol 2:1069–1073. https://doi.org/10.1016/S1542-3565(04)00444-6CrossRefPubMed

12.

Chang KJ, Albers CG, Erickson RA et al (1994) Endoscopic ultrasound-guided fine needle aspiration of pancreatic carcinoma. Am J Gastroenterol 89:263–266PubMed

13.

Khan MA, Grimm IS, Ali B et al (2017) A meta-analysis of endoscopic ultrasound–fine-needle aspiration compared to endoscopic ultrasound–fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment. Endosc Int Open 5:E363–E375. https://doi.org/10.1055/s-0043-101693CrossRefPubMedPubMedCentral

14.

Witt B, Adler D, Hilden K et al (2012) A comparative needle study: EUS-FNA procedures using the HD ProCore^TM and EchoTip® 22-gauge needle types. J Am Soc Cytopathol 1:S106. https://doi.org/10.1016/j.jasc.2012.08.230CrossRef

15.

Strand DS, Jeffus SK, Sauer BG et al (2014) EUS-guided 22-gauge fine-needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms: 22-Gauge FNA versus core biopsy in solid pancreatic masses. Diagn Cytopathol 42:751–758. https://doi.org/10.1002/dc.23116CrossRefPubMed

16.

Lee Y, Moon J, Kim H et al (2014) Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study. Endoscopy 46:1056–1062. https://doi.org/10.1055/s-0034-1377558CrossRefPubMed

17.

Alatawi A, Beuvon F, Grabar S et al (2015) Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United Eur Gastroenterol J 3:343–352. https://doi.org/10.1177/2050640615577533CrossRef

18.

Levy MJ (2007) Endoscopic ultrasound-guided trucut biopsy of the pancreas: prospects and problems. Pancreatology 7:163–166. https://doi.org/10.1159/000104240CrossRefPubMed

19.

de la Fuente SG, Arnoletti JP (2014) Beyond cytology: why and when does the oncologist require core tissue? Gastrointest Endosc Clin N Am 24:9–17. https://doi.org/10.1016/j.giec.2013.08.001CrossRefPubMed

20.

Fitzpatrick MJ, Hernandez-Barco YG, Krishnan K et al (2019) Diagnostic yield of the SharkCore EUS-guided fine-needle biopsy. J Am Soc Cytopathol 8:212–219. https://doi.org/10.1016/j.jasc.2019.03.001CrossRefPubMed

21.

Park JK, Lee KH (2019) Present and future of endoscopic ultrasound-guided tissue acquisition in solid pancreatic tumors. Clin Endosc 52:541–548. https://doi.org/10.5946/ce.2019.127CrossRefPubMedPubMedCentral

22.

Ang TL, Li JW, Kwek ABE et al (2019) The difference in histological yield between 19G EUS-FNA and EUS-fine-needle biopsy needles. Endosc Ultrasound 8:255–260. https://doi.org/10.4103/eus.eus_12_19CrossRefPubMedPubMedCentral

23.

Khoury T, Sbeit W, Ludvik N et al (2018) Concise review on the comparative efficacy of endoscopic ultrasound-guided fine-needle aspiration vs core biopsy in pancreatic masses, upper and lower gastrointestinal submucosal tumors. World J Gastrointest Endosc 10:267–273. https://doi.org/10.4253/wjge.v10.i10.267CrossRefPubMedPubMedCentral

24.

Ayres LR, Kmiotek EK, Lam E et al (2018) A comparison of endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy in the diagnosis of solid pancreatic lesions. Can J Gastroenterol Hepatol 2018:1415062. https://doi.org/10.1155/2018/1415062CrossRefPubMedPubMedCentral

25.

Larsen MH, Fristrup CW, Detlefsen S et al (2018) Prospective evaluation of EUS-guided fine needle biopsy in pancreatic mass lesions. Endosc Int Open 6:E242–E248. https://doi.org/10.1055/s-0043-124078CrossRefPubMedPubMedCentral

26.

Naveed M, Siddiqui AA, Kowalski TE et al (2018) A multicenter comparative trial of a novel EUS-guided core biopsy needle (SharkCore^TM) with the 22-gauge needle in patients with solid pancreatic mass lesions. Endosc Ultrasound 7:34–40. https://doi.org/10.4103/eus.eus_27_17CrossRefPubMedPubMedCentral

27.

Adler DG, Witt B, Chadwick B et al (2016) Pathologic evaluation of a new endoscopic ultrasound needle designed to obtain core tissue samples: a pilot study. Endosc Ultrasound 5:178–183. https://doi.org/10.4103/2303-9027.183976CrossRefPubMedPubMedCentral

28.

Fabbri C, Fornelli A, Fuccio L et al (2019) High diagnostic adequacy and accuracy of the new 20G procore needle for EUS-guided tissue acquisition: results of a large multicentre retrospective study. Endosc Ultrasound 8:261–268. https://doi.org/10.4103/eus.eus_14_19CrossRefPubMedPubMedCentral

29.

Di Leo M, Crinò SF, Bernardoni L et al (2019) EUS-guided core biopsies of pancreatic solid masses using a new fork-tip needle: a multicenter prospective study. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 51:1275–1280. https://doi.org/10.1016/j.dld.2019.03.025CrossRef

Title: Performance of EUS-FNB in solid pancreatic masses: a lesson from 463 consecutive procedures and a practical nomogram
Authors: Nico Pagano
Claudio Ricci
Carlo Ingaldi
Sinan Sadalla
Andrea Fabbri
Laura Alberici
Giovanna Impellizeri
Socrate Pallio
Rocco Maurizio Zagari
Antonio De Leo
Matteo Cescon
Riccardo Casadei
Publication date: 29-10-2021
Publisher: Springer International Publishing
Keywords: Ultrasound
Autoimmune Pancreatitis
Chronic Pancreatitis
Ultrasound
Neuroendocrine Tumor
Published in: Updates in Surgery / Issue 3/2022
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-021-01198-x

At a glance: The STEP trials

Springer Medicine

Performance of EUS-FNB in solid pancreatic masses: a lesson from 463 consecutive procedures and a practical nomogram

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2022

The real-word impact of breast and colorectal cancer surgery during the SARS-CoV-2 pandemic

Concomitance of intraductal papillary mucinous neoplasm with pancreatic stones: indication for immediate surgery

Foreword

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for advanced hepatocellular carcinoma with macrovascular invasion

Comparative review of outcomes: single-incision laparoscopic total extra-peritoneal sub-lay (SIL-TES) mesh repair versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia

Robotic transanal minimally invasive surgery: a single institutional experience