Current status and issues in genomic analysis using EUS-FNA/FNB specimens in hepatobiliary–pancreatic cancers

Abstract

Comprehensive genomic profiling based on next-generation sequencing has recently been used to provide precision medicine for various advanced cancers. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) play essential roles in the diagnosis of abdominal masses, mainly pancreatic cancers. In recent years, CGP analysis using EUS-FNA/FNB specimens for hepatobiliary–pancreatic cancers has increased; however, the success rate of CGP analysis is not clinically satisfactory, and many issues need to be resolved to improve the success rate of CGP analysis. In this article, we review the transition from EUS-FNA to FNB, compare each test, and discuss the current status and issues in genomic analysis of hepatobiliary–pancreatic cancers using EUS-FNA/FNB specimens.

Endoscopic Ultrasound-Guided Tissue Sampling for the Cytohistological Diagnosis of Focal Liver Lesions

“…However, recent research supports the feasibility of this approach. Choi et al performed EUS-guided tissue acquisition using core needles for solid liver cancers in the left lobe [ 31 ]. In this study, 12 patients had primary liver cancer, including four cases of hepatocellular carcinoma and seven of intrahepatic cholangiocarcinoma, while 16 had metastatic liver cancer.…”

Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides

“…EUS‐FNB is superior to EUS‐FNA in providing adequate samples for CGP testing. 15 , 25 , 26 , 27 Although the technical excellence of 19G‐FNB has been demonstrated in clinical practice, its sampling adequacy remains limited. Hence, further efforts are required to improve the sampling adequacy for CGP tests.…”

Is genomic analysis possible in a tissue acquired via endoscopic ultrasound-guided fine-needle biopsy in cholangiocarcinoma?

“…Furthermore, gallbladder carcinoma (GBC) is associated with pathogenic EGFR, ERBB2/3, PTEN, ARID2, MLL2/3, TERT, TP53, BRCA1/2, and PIK3CA variants. 5 FGFR2 variants have been studied extensively in the context of intrahepatic CCA, and therapies targeting such genetic changes, including pemigatinib and futibatinib, demonstrated promising response rates of 35.5% and 42%, respectively, when used as second-line treatments. 6 , 7 …”

“…However, the tissue quantity adequacy rates remained undocumented in these reports. 5 These studies were predominantly limited by patient selection, with most enrolled patients suffering from intrahepatic CCA or GBC and very few cases representing ductal infiltration and extrahepatic CCA. Notably, a study evaluating EUS-FNA efficacy in pancreatic cancer reported CGP adequacy rates of 72.5%, 53.5%, and 33.3% for 19-G-FNB, 22-G-FNB, and 22-G-FNA, respectively.…”