EUS-guided through the needle microbiopsy: a useful adjunct in the investigation of pancreatic cystic lesions

Abstract

ObjectiveEndoscopic ultrasound-guided through-the-needle microbiopsy (EUS-TTNB) forceps is a recent development that facilitates sampling of the walls of pancreatic cystic lesions (PCL) for histological analysis. We aimed to assess the impact of EUS-TTNB and its influence on patient management in a tertiary pancreas centre.DesignA prospective database of consecutive patients who underwent EUS-TTNB from March 2020 to August 2022 at a tertiary referral centre was retrospectively analysed.ResultsThirty-four patients (22 women) were identified. Technical success was achieved in all cases. Adequate specimens for histological diagnosis were obtained in 25 (74%) cases. Overall, EUS-TTNB led to a change in management in 24 (71%) cases. Sixteen (47%) patients were downstaged, with 5 (15%) discharged from surveillance. Eight (24%) were upstaged, with 5 (15%) referred for surgical resection. In the 10 (29%) cases without change in management, 7 (21%) had confirmation of diagnosis with no change in surveillance, and 3 (9%) had insufficient biopsies on EUS-TTNB. Two (6%) patients developed post-procedural pancreatitis, and 1 (3%) developed peri-procedural intracystic bleeding with no subsequent clinical sequelae.ConclusionEUS-TTNB permits histological confirmation of the nature of PCL, which can alter management outcomes. Care should be taken in patient selection and appropriately consented due to the adverse event rate.

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

“…EUS-TTNB is one of the most recent and promising techniques for the definition of PCLs, with excellent technical success (98.5%, CI 97.3-99.6%) and high accuracy (86.7%, CI 80.1-93.4) according to a recent metanalysis [15]. Several studies have compared TTNB to standard EUS-FNA, with conventional fluid analysis demonstrating the clear superiority of TTNB in risk stratification and its ability to provide a specific diagnosis [8,9,[11][12][13][38][39][40][41][42][43][44][45][46][47][48]. Moreover, a study demonstrated that EUS-TTNB specimens are suitable for molecular analyses [49].…”