Optimization of endoscopic ultrasound‐guided tissue sample acquisition for commercially available comprehensive genome profiling

Abstract

Background and AimOptimal tumor samples are crucial for successful analysis using commercially available comprehensive genomic profiling (CACGP). However, samples acquired by endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) are occasionally insufficient, and no consensus on the optimal number of needle passes required for CACGP exists. This study aimed to explore the optimal number of needle passes required for EUS‐TA to procure an ideal sample fulfilling the prerequisite criteria of CACGPs.MethodsPatients who underwent EUS‐TA for solid masses between November 2019 and July 2021 were retrospectively studied. The correlation between the acquisition rate of an ideal sample and the number of needle passes mounted on a microscope slide was evaluated. Additionally, the factors predicting a successful analysis were investigated in patients scheduled for CACGP using EUS‐TA‐obtained samples during the same period.ResultsEUS‐TAs using 22‐ and 19‐gauge (G) needles were performed in 336 and 57 patients, respectively. There was a positive correlation between the acquisition rate and the number of passes using a 22‐G needle (38.9%, 45.0%, 83.7%, and 100% for 1, 2, 3, and 4 passes, respectively), while no correlation was found with a 19‐G needle (84.2%, 83.3%, and 85.0% for 1, 2, and 3 passes, respectively). The analysis success rate in patients with scheduled CACGP was significantly higher with ideal samples than with suboptimal samples (94.1% vs 55.0%, P < 0.01).ConclusionsThe optimal estimated number of needle passes was 4 and 1–2 for 22‐ and 19‐G needles, respectively.

Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides

“…6,49 In addition, using 19G or 22G needles at the first puncture achieves more favorable histological suitability than using a 25G needle. 25 Although several reports have suggested that 1-4 punctures are appropriate for CGP tests, 25,49,50 the present study demonstrated that the sample volume increased with the improvement of the formalin fixation process, regardless of needle type, needle thickness, or the number of punctures. This finding indicates that the oil blotting paper method may increase the available specimen volumes on the glass slide, thus improving the EUS-TA technique.…”

Editorial: Endoscopic ultrasound‐guided tissue acquisition in the era of precision medicine

“…reported that in a cohort of 98 patients who underwent EUS‐TA (82 pancreas target organ), the adequacy rate for CACGP testing was significantly higher with a 19‐G FNB needle (72.5%), compared with 22‐G FNB (53.5%) and 22‐G FNA (33.3%) needles 6 . The current study adds to the existing literature by further clarifying technical details needed to obtain sufficient tissue sample for improving the success rate of CACGP testing 3 …”

“…In this issue of Journal of Gastroenterology and Hepatology , Ishikawa et al . examined factors for optimization of EUS‐FNB for CGP using F1CDx 3 . This was a retrospective observational study in which EUS‐FNB had been performed in 393 patients, predominantly PDAC (283 patients, 72%), of which 54 underwent F1CDx analysis.…”

Feasibility of comprehensive genomic profiling using endoscopic ultrasound‐guided tissue acquisition with a 22‐gauge Franseen needle

“…One retrospective study suggested the number of passes was associated with successful CGP tests in 22‐gauge needles, but not in 19‐gauge needles. 37 The appropriate number of passes both for 19‐ and 22‐gauge needles should be further evaluated in the context of CGP tests.…”