Diagnostic performance of endoscopic ultrasound-guided tissue acquisition by EUS-FNA versus EUS-FNB for solid pancreatic mass without ROSE: a retrospective study

Abstract

Background Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is an established diagnostic procedure for solid pancreatic mass. However, the diagnostic yield between fine-needle aspiration (FNA) and fine-needle biopsy (FNB) remains unclear. We aimed to evaluate and compare the diagnostic yields between FNA and FNB using conventional FNA and Franseen needles of the same size 22-gauge needle, in patients with solid pancreatic mass who underwent EUS-TA without rapid onsite cytopathology evaluation (ROSE). Methods All cases of EUS-TA by FNA or FNB for solid pancreatic mass between January 2017 and October 2020 in a single-centre university hospital were retrospectively reviewed. All procedures were performed without an onsite cytologist. Before the endoscopist finished the procedure, macroscopic onsite evaluation (MOSE) was confirmed. The diagnostic yield and the average number of needle passes between FNB and FNA were then compared. Results A total of 151 patients (FNA, n = 77; FNB, n = 74) with solid pancreatic mass detected by cross-sectional imaging underwent EUS-TA. The mean age was 62.3 ± 12.8 years, with 88 (58.3%) males. Age, sex, mass location, tumour size and disease stage from imaging were not significantly different between the two groups. The diagnostic performance was higher in EUS-FNB (94.6%) than in EUS-FNA (89.6%). The mean number of needle passes was clearly fewer in FNB than in FNA (2.8 vs. 3.8, p < 0.001). The total procedure time was shorter in FNB (34.7 min) than in FNA (41 min). The adverse event rate between FNB and FNA was not significantly different. Conclusions The diagnostic yield of solid pancreatic mass was higher in FNB using the Franseen needle than in FNA using the conventional FNA needle in a centre where ROSE is unavailable, without serious adverse event. In addition, FNB had fewer needle passes and shorter total procedure time.

Endoscopic Ultrasound Guided Fine Needle Aspiration versus Endoscopic Ultrasound Guided Fine Needle Biopsy for Pancreatic Cancer Diagnosis: A Systematic Review and Meta-Analysis

“…Two studies looked at the sampling duration and the time added for rapid onsite pathological evaluation (ROSE) [ 20 , 21 , 22 , 24 , 25 , 26 , 27 ]. In the study of Oppong et al (2020), the median time for diagnosis was about 188 s for EUS-FNB vs. 332 s for EUS-FNA ( p < 0.001) [ 21 , 27 , 28 ].…”

“…Finally, Oppong et al (2020) have also evaluated the diagnostic facility and the cost of both of the diagnostic methods [ 21 ]. They observed that practicing the EUS-FNB was associated with a higher diagnostic facility when there was any significant difference in terms of financial costs against the types of needles [ 23 , 24 , 25 , 26 ].…”

“…However, it must be noted that many factors can affect the diagnostic precision, such as the location and the characteristics of the lesion, the technician’s experience, the needles caliber and the pass amount [ 22 , 23 ]. For example, Jani et al (2019) in their study, observed that optimal attainment of tissues from the lesions depends on factors like the size of the needles caliber, the presence of cytotechnicians for a speed evaluation on sight, the valuation of the endoscopist and the manipulation techniques of the tissues [ 25 , 26 , 27 , 28 ]. Future research could look at the impact of those other factors on the EUS-FNB diagnostic yield [ 29 , 30 ].…”

Groove Pancreatitis: Clinical Cases and Review of the Literature

“…To our knowledge, there are no studies comparing EUS-guided FNA versus FNB, specifically in GP. However, recently, Wong et al [ 20 ] compared the diagnostic performance of EUS-guided tissue acquisition by EUS-guided FNA versus EUS-guided FNB for solid pancreatic mass, and they found that the diagnostic yield of solid pancreatic mass was higher in FNB than in FNA (94.6 vs. 89.6%).…”

Endoscopic ultrasound guided fine-needle biopsy versus endoscopic ultrasound guided fine-needle aspiration in the diagnosis of pancreatic and extrapancreatic solid lesions

“…One episode of mild acute pancreatitis was noted in FNB group, while a prolonged hemorrhage which resolved spontaneously was noted in FNA group. 1 2 3…”