Diagnostic Fine-Needle Biopsy of Small Solid Pancreatic Lesions Using a Franseen Needle during Endoscopic Ultrasound Examination

Abstract

Background and aim: During endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNB), Franseen needles can help collect sufficient tissue to permit histopathological assessment. However, its efficacy might be limited by the size of the targeted lesion. This study aimed to evaluate the feasibility of histopathological assessment of small solid pancreatic lesions using a 22-gauge Franseen needle during EUS-FNB. Methods: This retrospective study evaluated data from all patients who underwent EUS-FNB using a Franseen needle for solid pancreatic lesions at the University of Toyama Hospital between June 2018 and April 2020. Results: The study included 159 patients who had 152 malignant lesions and 7 benign lesions. The malignant lesions included pancreatic cancers (n = 134), neuroendocrine neoplasms (n = 15), metastatic tumors (n = 2), and a solid pseudopapillary neoplasm (n = 1). The diagnostic accuracy of EUS-FNB (combining histology and cytology) was 98.7%. However, the histopathological diagnosis was only confirmed for 64.3% of small lesions (<10 mm), relative to 97.2% for larger lesions. Multivariate analysis also revealed that lesion size of <10 mm predicted a less accurate histopathological diagnosis (odds ratio: 6.97, 95% confidence interval: 1.02–47.67; p = 0.041). Further analyses revealed a failed histological diagnosis in 4 patients with lesions of <5 mm in size and accurate diagnoses in 9 out of 10 patients with lesions of 5–10 mm in size. Conclusions: The diagnostic accuracy for small lesions (<10 mm), especially for lesions of <5 mm, based on histological examination alone, was significantly lower than that for others (>10 mm). Furthermore, multivariate analysis revealed that only lesion size was an independent predictor of histopathological diagnosis accuracy.

Clinical dilemma of endoscopic ultrasound‐guided fine needle aspiration for resectable pancreatic body and tail cancer

“…Multivariate analysis confirmed that EUS-FNA has a low diagnostic accuracy for small pancreatic lesions, especially those <5 mm. 20 Similar results were reported by other retrospective cohort studies. 21,22 These studies indicate that the diagnosis of small pancreatic lesions (<10 mm) by EUS-FNA remains challenging.…”

“…One of the disadvantages of EUS-FNA is its low diagnostic accuracy for small lesions. Takahashi et al 20…”

Comparison of Histological Sample Volumes among Various Endoscopic Ultrasound-Guided Biopsy Needles

“…Third, this study excluded both small lesions (<20 mm) and transduodenal puncture routes. We previously reported that lesion size was an independent predictor of histopathological diagnosis accuracy with a 22-gauge Franseen needle using a multivariate analysis [25]. Regarding a transduodenal puncture route, there are several technical issues with the use of a large-caliber 19-gauge needle due to its stiffness.…”

Diagnostic Management of Gastroenteropancreatic Neuroendocrine Neoplasms: Technique Optimization and Tips and Tricks for Radiologists

“…EUS plays a decisive role in defining GEP-NENs of the gastrointestinal wall, as it provides information on the size, depth of invasion, and local–regional metastases [ 164 ]. The EUS-guided biopsy can also provide a definitive diagnosis and useful information (for example, the evaluation of the nuclear protein Ki-67, which appears to be a proliferative index) for correctly managing this type of lesion [ 165 ]. In addition, the EUS can accurately select the ideal candidates for the endoscopic resection.…”