Fine‐needle biopsy with 19G needle is effective in combination with endoscopic ultrasound‐guided tissue acquisition for genomic profiling of unresectable pancreatic cancer

Abstract

Objectives: Comprehensive genomic profiling (CGP) has been approved in Japan since June 2019, enabling mutation-specific therapy. Although tissue sampling via endoscopic ultrasoundguided tissue acquisition (EUS-TA) is standard in pancreatic cancer, reports on obtaining appropriate samples for CGP, especially for the OncoGuide NCC Oncopanel System (NOP) and FoundationOne CDx (FOne), are lacking. Therefore, we investigated the success rate and factors related to appropriate EUS-TA sampling for CGP analysis suitability in unresectable pancreatic ductal adenocarcinoma (UR-PDAC).Methods: Participants comprised 150 UR-PDAC patients who underwent EUS-TA and tumor sample evaluation for CGP analysis suitability between June 2019 and December 2021. The proportion of patients meeting the criteria was evaluated considering tumor size, puncture lesion, presence of metastasis, type and size of puncture needle, suction method, number of punctures, and puncture route.Results: In total, 39.2% (60/153) of samples met NOP analysis suitability criteria and 0% met FOne analysis suitability criteria. The suitability rate was significantly higher with 19G fine-needle biopsy (FNB) (56.0%; 42/75) than with 22G FNB (32.6%; 14/43) and 22G fine-needle aspiration (11.4%; 4/35). Nineteen-gauge needle (odds ratio [OR] 2.53; 95% confidence interval [CI] 1.15-5.57; P = 0.021) and FNB (OR 3.57; 95% CI 1.05-12.20; P = 0.041) were independent factors contributing to NOP analysis suitability. Among 30 patients who underwent actual NOP analysis, the analysis success rate was 100% (30/30). Conclusion:In sample collection via EUS-TA, 19G and FNB needles contribute to NOP analysis suitability.

Next-Generation Sequencing Analysis of Pancreatic Cancer Using Residual Liquid Cytology Specimens from Endoscopic Ultrasound—Guided Fine-Needle Biopsy: A Prospective Comparative Study with Tissue Specimens

“…The frequency of mutations identified in this study is consistent with previous PC studies, with KRAS , TP53 , CDKN2A , and SMAD4 recorded as the most commonly mutated genes [ 5 , 9 , 35 ]. Using a customized gene panel of 28 cancer-related genes, genomic profiles were successfully generated from 26 of 30 patient samples (86.7%).…”

“…Several studies have demonstrated NOP analysis suitability criteria for EUS-FNB using a 19-guage needle for patients with unresectable PC [ 22 , 35 ]. Moreover, one prospective and two retrospective studies have reported on comprehensive genomic testing using 22-guage FNB needles [ 36 , 37 , 38 ].…”

Is endoscopic ultrasound‐guided tissue acquisition suitable for comprehensive genetic profiling?

“…In the present study, 10 the authors concluded that 19G and FNB needles are suitable for CGP analysis, but also that larger needles require a higher degree of skill for puncture and that the complication rate is concerning, although it did not reach the level of significant difference. Moreover, as 22G FNB needles are currently the most commonly used needle type in the real‐world setting, further investigation is warranted in terms of appropriate puncture number, puncture method, and ingenuity in obtaining formalin‐fixed paraffin‐embedded samples.…”

“…In this issue of Digestive Endoscopy , Ikeda et al 10 . performed a retrospective study assessing the CGP criteria suitability using EUS‐TA samples in a larger number of patients ( n = 150) than the previous reports.…”

Endoscopic Ultrasound-Guided Tissue Acquisition of Pancreaticobiliary Cancer Aiming for a Comprehensive Genome Profile

“…Ikeda et al [ 48 ] retrospectively investigated the percentage of cases achieving NCCOP analysis criteria (153 cases in total; FNB 19-G needle: 75 cases, FNB 22-G needle: 43 cases, and FNA 22-G needle: 35 cases). Overall, only 39.0% (60/153) of cases met the NCCOP analysis criteria.…”