Evaluating triage protocols for endoscopic ultrasound-guided fine needle biopsies of the pancreas

Endoscopic Ultrasound–guided Fine-needle Biopsy With or Without Rapid On-site Evaluation for Diagnosis of Solid Pancreatic Lesions: A Randomized Controlled Non-Inferiority Trial

“…24 Theoretically, the availability of both cytologic and histologic specimens could represent a diagnostic advantage over EUS-FNB alone, as suggested by recent large retrospective studies. 25,26 However, EUS-FNB alone performed with new FNB needles demonstrated diagnostic accuracy of greater than 90% in prospective studies, 27,28 and no randomized trial has investigated the benefit of ROSE with TIC on FNB specimens. Therefore, we hypothesized that EUS-FNB alone was noninferior to EUS-FNBþROSE, and we aimed to compare the diagnostic accuracy of EUS-FNB alone versus EUS-FNBþROSE with TIC in patients with newly diagnosed SPLs.…”

The value of concurrent endoscopic ultrasound‐guided fine needle aspirates and needle core biopsies in the diagnosis of pancreatic neoplasms

“…EUS-needle core biopsy offers the additional benefit of obtaining a large enough volume of lesional tissue (Figure 1) for not only histologic assessment but also ancillary studies including immunohistochemistry and molecular analysis; a limiting factor of FNA. 4,7 At our institution EUS-guided FNAs and needle core biopsies are performed concurrently to increase the diagnostic yield and to obtain sufficient material for ancillary tests. In the age of precision medicine multiple recuts of either cell block or histologic slide material are needed for molecular analysis.…”

“…So too, EUS‐guided needle core biopsy is an effective diagnostic tool for sampling pancreatic lesions. EUS‐needle core biopsy offers the additional benefit of obtaining a large enough volume of lesional tissue (Figure 1) for not only histologic assessment but also ancillary studies including immunohistochemistry and molecular analysis; a limiting factor of FNA 4,7 …”

“…Discordant diagnoses are attributed primarily to sampling as the fibrotic nature of the tumor may hinder procurement of an FNA sample. For comparison, Fitzpatrick and colleagues 7 reported a greater nondiagnostic rate of 6% for needle core biopsies compared to 3% for concurrent FNA smears; findings attributed to lower tissue quality/scanty cellularity on tissue samples. There is controversy in the literature as to the diagnostic accuracy of FNAs versus needle core biopsies.…”

“…Although some studies 7 have reported that simultaneous review of FNA smears and needle core biopsies by cytopathologists could optimize EUS‐FNA performance, all biopsies at our institution are interpreted by fellowship‐trained gastrointestinal pathologists. Routine cyto‐histologic correlation is subsequently performed by cytopathologists to compare both the EUS‐FNA and EUS‐needle core biopsy findings.…”