Endoscopic Ultrasound-Guided Fine-Needle Biopsy versus Fine-Needle Aspiration in the Diagnosis of Focal Liver Lesions: Prospective Head-to-Head Comparison

Abstract

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA) from focal liver lesions are indicated in selected cases, but there has been no previous comparison of needle types of the same size. The aim of our study was to compare the histologic diagnostic accuracy and adequacy of cores obtained with EUS-FNB needles in contrast to those obtained with FNA needles in focal liver lesions. This prospective one-center study included patients with left lobe hepatic focal lesions with contraindications for percutaneous liver biopsy or need for EUS for concomitant lesions. Each patient had one pass of 22G EUS-FNB (Franseen) needle and one pass of 22G EUS-FNA in a crossover manner, without macroscopic on-site evaluation. Each sample was analyzed separately for histologic adequacy and diagnosis. The final diagnosis was based on histology results or on imaging follow-up in the case of negative biopsies. The EUS-FNB samples (n = 30) were found to be more adequate for histologic analysis, with more cellularity and longer tissue aggregates than the EUS-FNA samples (n = 30). The accuracy of EUS-FNB was 100%, whereas that of EUS-FNA was 86.7% (p = 0.039). No post-procedure complications were noted. The 22G EUS-FNB needle proved superior to 22G EUS-FNA in terms of tissue acquisition diagnostic accuracy and histologic adequacy in focal liver lesions.

Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion

“…The majority of the biopsies, 83%, were from the left liver lobe and 17% from the right, with no significant difference in diagnostic accuracy between the lobes. Similar results were obtained by Gheorghiu et al [ 41 ].…”

“…Studies from the last decade using 22 G FNA evidenced high efficacy and diagnostic accuracy for liver malignancy diagnosis[ 14 , 40 , 41 ]. In a retrospective small study conducted by Akay et al [ 14 ] on 25 patients with liver masses, the success rate and the diagnostic accuracy using FNA 22G and only 1 pass were evaluated.…”

“…A head-to-head comparison of 22G FNA vs 22G FNB in the diagnosis of focal liver lesions was conducted by Gheorghiu et al [ 41 ]. This trial prospectively included 32 patients diagnosed with solid hepatic masses by CT scan and unsuitable for PC LB or requiring a EUS-guided sampling from both pancreas and focal liver lesions.…”

Endoscopic ultrasound-guided tissue acquisition beyond the pancreas

“…The diagnostic accuracy of EUS-FNB was 100%, while that of EUS-FNA was 86.7% (P=0.039). This study compared 22-G EUS-FNB needles and 22-G EUS-FNA needles without macroscopic field evaluation [ 21 ]. Similarly, a comparison between FNA and FNB needles for LB was also conducted using 19-G-size needles.…”

Comparison of Diagnostic Performances in Endoscopic Ultrasound-guided Liver Biopsy using Different Techniques

“…There was statistically no difference in diagnostic accuracy between suction and slow-pull suction (79.8% vs. 84.9%, P=0.308). Slow-pull suction obtained more adequate specimen comparing to suction (95.0% vs. 87.4%, P=0.040) 1 2 .…”