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

Abstract

Endoscopic ultrasound (EUS)-guided fine needle aspiration with or without biopsy (FNA/FNB) are the primary diagnostic tools for gastrointestinal submucosal tumors. EUS-guided fine needle aspiration (EUS-FNA) is considered a first line diagnostic method for the characterization of pancreatic and upper gastrointestinal lesions, since it allows for the direct visualization of the collection of specimens for cytopathologic analysis. EUS-FNA is most effective and accurate when immediate cytologic assessment is permitted by the presence of a cytopathologist on site. Unfortunately, the accuracy and thus the diagnostic yield of collected specimens suffer without this immediate analysis. Recently, a EUS-FNB needle capable of obtaining core samples (fine needle biopsy, FNB) has been developed and has shown promising results. This new tool adds a new dimension to the diagnostic and therapeutic utility of this technique. The aim of the present review is to compare the efficacy of EUS-FNA to that afforded by EUS-FNB in the characterization of pancreatic masses and of upper and lower gastrointestinal submucosal tumors.

Solid Pseudopapillary Neoplasm of the Pancreas: Unfolding an Intriguing Condition

“…Provided that the correct preoperative diagnosis of SPN substantially relies on a cyto-histologic and immunohistochemical analysis, and taking into account the most recent studies comparing the role of FNB versus FNA in the diagnosis of pancreatic masses, EUS-FNB should be considered the gold standard option when tissue acquisition is required to obtain preoperative diagnosis of a SPN, since it provides better specimen adequacy with less needle passes [32][33][34].…”

Deconvolution microscopy: A platform for rapid on‐site evaluation of fine needle aspiration specimens that enables recovery of the sample

“…The advantage of cytology (less invasive, lower risk, potentially faster diagnosis) is offset by its lower definitive diagnosis rate compared to traditional core needle or excision biopsies 14 1 : poor performance of microbiopsy devices and difficulties in specimen handling are probably as important as the difficulty cytologists face in interpreting fewer or smaller fragments.…”

“…The advantage of cytology (less invasive, lower risk, potentially faster diagnosis) is offset by its lower definitive diagnosis rate compared to traditional core needle or excision biopsies. 14 The reasons for the lower definitive diagnostic rate are multi‐fold, but they can probably mostly be attributed to technical problems 1 : poor performance of microbiopsy devices and difficulties in specimen handling are probably as important as the difficulty cytologists face in interpreting fewer or smaller fragments. Nevertheless, cytology is the best or even the only choice for making a diagnosis in certain clinical scenarios, such as ultrasound‐guided endoscopic biopsy, or biopsy next to vital structures.…”

EUS-FNA Biopsies to Guide Precision Medicine in Pancreatic Cancer: Results of a Pilot Study to Identify KRAS Wild-Type Tumours for Targeted Therapy

“…EUS-FNA using 19 to 25-guage needles is a long-established technique in the diagnosis and staging of pancreatic tumours, and a number of studies have investigated technical aspects to improve the diagnostic performance of the procedure ( 17 , 18 ). The first generation of FNA biopsy needles provide aspirates of suspicious lesions but often yield lowly cellular specimens lacking in architectural tissue structure, which may be critical for diagnosis as well as for the increasingly desired immunohistochemical and genomic analysis of pancreatic tumours ( 19 , 20 ). However, newer generation needles allow for larger tissue cores, and have been demonstrated to require fewer needle passes to establish a diagnosis ( 21 , 22 ).…”