Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions

Crinò, Stefano Francesco; Bernardoni, Laura; Brozzi, Lorenzo; Barresi, Luca; Malleo, Giuseppe; Salvia, Roberto; Frulloni, Luca; Sina, Sokol; Parisi, Alice; Remo, Andrea; Larghi, Alberto; Gabbrielli, Armando; Manfrin, Erminia

doi:10.1016/j.gie.2019.05.009

Cited by 51 publications

(99 citation statements)

References 33 publications

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“…The microforceps can be advanced through the lumen of a standard 19gauge EUS-FNA needle for through-the-needle tissue biopsy (TTNB) of PCs. Since its introduction, there have been several studies reporting on the performance of the TTNB [16][17][18][19][20][21][22][23][24][25][26][27][28]. We performed a systematic review and meta-analysis of the current literature to better assess the feasibility, safety, and diagnostic yield of TTNB as compared to EUS-FNA in the evaluation of PCs.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

et al. 2020

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IntroductionPancreas cysts (PCs) are being diagnosed with increasing frequency given the widespread use of cross-sectional imaging in our health care system [1]. PCs can be broadly categorized as either non-neoplastic or neoplastic, with the latter being estimated as high as 13.5 % in the general population [2]. Accurate diagnosis and risk stratification of neoplastic cysts are crucial as to provide guidance for the most appropriate management strategy.The optimal diagnostic approach to PCs remains unclear as there is currently no single test that can reliably differentiate non-neoplastic PCs from those lesions with malignant potential or harboring malignancy. Given the well-recognized limitations of imaging alone [2-4], EUS-guided fine-needle aspiration (EUS-FNA) for cytology and cyst fluid analysis is the commonly performed guideline endorsed test for aid with diagnosis and risk stratification [4][5][6][7][8][9][10]. FNA cytology is often limited by the scant cellularity within the cyst fluid [11,12]. While cyst fluid carcinoembryonic antigen (CEA) has been traditionally used to differentiate mucinous versus non-mucinous PCs [13], it has ABSTR AC T Background and study aims Accurate diagnosis and risk stratification of pancreatic cysts (PCs) is challenging. The aim of this study was to perform a systematic review and meta-analysis to assess the feasibility, safety, and diagnostic yield of endoscopic ultrasound-guided through-theneedle biopsy (TTNB) versus fine-needle aspiration (FNA) in PCs. MethodsComprehensive search of databases (PubMed, EMBASE, Cochrane, Web of Science) for relevant studies on TTNB of PCs (from inception to June 2019). The primary outcome was to compare the pooled diagnostic yield and concordance rate with surgical pathology of TTNB histology and FNA cytology of PCs. The secondary outcome was to estimate the safety profile of TTNB. Results: Eight studies (426 patients) were included. The diagnostic yield was significantly higher with TTNB over FNA for a specific cyst type (OR: 9.4; 95 % CI: [5.7-15.4]; I 2 = 48) or a mucinous cyst (MC) (OR: 3.9; 95 % CI: [2.0-7.4], I 2 = 72 %). The concordance rate with surgical pathology was significantly higher with TTNB over FNA for a specific cyst type (OR: 13.5; 95 % CI: [3.5-52.3]; I 2 = 48), for a MC (OR: 8.9; 95 % [CI: 1.9-40.8]; I 2 = 29), and for MC histologic severity (OR: 10.4; 95 % CI: [2.9-36.9]; I 2 = 0). The pooled sensitivity and specificity of TTNB for MCs were 90.1 % (95 % CI: [78.4-97.6]; I 2 = 36.5 %) and 94 % (95 % CI: [81.5-99.7]; I 2 = 0), respectively. The pooled adverse event rate was 7.0 % (95 % CI: [2.3-14.1]; I 2 = 82.9).Conclusions TTNB is safe, has a high sensitivity and specificity for MCs and may be superior to FNA cytology in riskstratifying MCs and providing a specific cyst diagnosis. Supplementary materialOnline content viewable at: https://doi.

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Section: Introductionmentioning

confidence: 99%

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

et al. 2020

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“…The forceps were then "plucked" and removed from the patient, leaving the 19-gauge needle in the cyst. Crino et al [16], found that a mean number of 3.25 passes per patient was necessary to obtain 3 visible histologic specimens, which were judged to be adequate for histologic evaluation in approximately 92 % and performed one "bite" per pass from observing the "tent sign" of the cystic wall, which theoretically demonstrates an effective grip of the microforceps on the wall. With the protocol of Crino ▶ et al, they reached 100 % histologic adequacy after two biopsy samples.…”

Section: Discussionmentioning

confidence: 99%

“…Other technical difficulties described did not hinder procurement of specimens. Failures were seen in locations where EUS-guided puncture is known to be challenging, i. e., when the echoendoscope was placed in the duodenum [16]. In the study by Barresi et al [14], specimens were considered adequate for histological diagnosis in 47 of 56 (83.9 %; 95 % CI, 72 %-92 %).…”

Section: Discussionmentioning

confidence: 99%

“…Basar et al [15] reported that pinch biopsy specimen was insufficient for histology processing in four of 42 patients (9.6 %), two from a cyst wall and two from a septum. Crino et al [16], reported that inadequacy was because of clots in 10 cases and amorphous material in five cases. Mittal et al [18] no reported procedural difficulty, but microforceps biopsies did not provide a pathologic diagnosis in three cases because tissue obtained with the microforceps biopsy was not adequate for pathologic diagnosis.…”

Section: Studymentioning

confidence: 98%

“…Another patient had self-limited intracystic bleeding, which did not progress and did not result in any symptoms. Crino et al [16] observed a case of transitory fever with possible cyst infection, which resolved with conservative treatment without the need for hospital admission. In this cohort, they observed an overall AEs rate of 22.9 %, with a slight increase in intracystic bleeding (16.4 %).…”

Section: Studymentioning

confidence: 99%

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Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

et al. 2020

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Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs. Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis). Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %). Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

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A new micro‐forceps for endoscopic ultrasound‐guided through‐the‐needle biopsy in the diagnosis of pancreatic cystic lesions: Single center experience

2021

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Background and Aim Endoscopic ultrasound (EUS)‐guided through‐the‐needle biopsy (TTNB) has improved the diagnostic algorithm of pancreatic cystic neoplasms (PCNs). Recently, a new through‐the‐needle micro‐forceps device (Micro Bite, MTW Endoskopie Manufakture) has been introduced. The primary aim was to assess the safety and technical success of this new type of micro‐forceps. The secondary aim was to evaluate the diagnostic role of EUS‐TTNB. Methods Retrospective study of consecutive patients receiving EUS‐TTNB for the diagnosis of PCNs. Two micro‐forceps were used: Moray Micro‐forceps and Micro‐Bite. Cystic fluid was collected for cytological analysis. Categorical variables were analyzed by Fisher's exact test, and continuous variables were analyzed by Student's t‐test. P < 0.05 was considered significant. Results Forty‐nine patients enrolled in the study (24% male; mean age 63 ± 14 years). TTNB was successfully performed in all patients. A diagnostic sample was obtained in 67.3% PCNs with TTNB compared with 36.7% with cyst fluid cytology (P 0.01). Adverse events rate was 10.2% and occurred in older patients (76.6 ± 5.4 vs 61.3 ± 13.7 P = 0.02). The 51% underwent EUS‐TTNB with Micro Bite. A diagnostic sample was obtained in 52% PCNs with Micro Bite compared with 24% obtained with cyst fluid cytology (P = 0.07). Comparing the two devices, the rate of diagnostic sample obtained with the micro‐forceps Moray was higher than that obtained with the Micro Bite (20/24 [83.3%] vs 13/25 [52%] P 0.03). Conclusions EUS‐TTNB increases the diagnostic yield of PCNs. The new Micro‐Bite could represent a valid alternative to the currently used Moray Micro‐forceps, but its diagnostic rate is still suboptimal and further studies are needed.

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Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions

Cited by 51 publications

References 33 publications

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

A new micro‐forceps for endoscopic ultrasound‐guided through‐the‐needle biopsy in the diagnosis of pancreatic cystic lesions: Single center experience

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