Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

Abstract

INTRODUCTIONDifferential diagnosis of pancreatic masses is a frequent clinical challenge. Therapeutic decision in this context is mainly based on the ability to establish or exclude malignancy [1] . Although ductal adenocarcinoma is the most frequent cause of pancreatic masses, other neoplasms (e.g. lymphoma, cystic tumours) and benign conditions (e.g. chronic pancreatitis) with different prognoses and treatment options can arise within the pancreas. A histological diagnosis becomes therefore highly relevant for an optimal therapeutic decision [2] . Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been proved to be a safe and useful method for tissue sampling of intramural and extramural gastrointestinal lesions including the pancreas [3,4] . Cytological study of the materials obtained by FNA allows the evaluation of cellular findings suggestive of malignancy, such as anisonucleosis, nuclear membrane irregularity and nuclear enlargement. Unfortunately, inflammation causes a reactive and regenerative process leading to cellular changes that can be difficult to distinguish from well-differentiated neoplasias. Histological study of tissue samples allows the assessment of tissue architecture and cell morphology, as well as the performance of immunohistochemical analysis [5,6] , thus usually providing with a higher diagnostic accuracy than cytology.Retrieving Abstract AIM: To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) material in the differential diagnosis of pancreatic solid masses. METHODS:Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs (22G needle) were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Materials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS:Length of the core specimen obtained for histological analysis was 6.5 ± 5.3 mm (range 1-22 mm). Cytological and histological samples were considered as adequate in 51 (82.3%) and 52 cases (83.9%), respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Contrary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases (90.3%), with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%. CONCLUSION:Adequate pancreatic core specimens for

High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial

“…A 25-gauge needle is therefore recommended to puncture the head of the pancreas 4 . Several studies have compared the performance characteristics of a 22-gauge needle with those of a 25-gauge FNA needle for sampling pancreatic masses, but most have failed to demonstrate superiority of either needle [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . A recent systematic review and meta-analysis of EUS-FNA for solid pancreatic masses, including a large cohort of patients, revealed that a 25-gauge needle was more sensitive than a 22-gauge needle 23 .…”

Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: A multicenter study

“…Although the specificity of EUS-FNA is close to 100% [24][25][26][27][28] , it has the potential to miss micro-invasion of malignancy into lymph nodes or to give false negative results for a necrotic pancreatic lesion. However, we consider it as representative of daily practice, particularly when it is combined with an adequate clinical and imaging follow-up period.…”

Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

“…Various EUS-guided techniques have been explored to retrieve tissue specimens, including FNA and Tru-Cut needles, with variable success and complication rates (25)(26)(27)(28)(29)(30)(31)(32). of particular interest is the quick-Core ® needle, designed to operate through an echoendoscope.…”