Su1335 FEASIBILITY AND SAFETY OF USING A 22-GAUGE ENDOSCOPIC ULTRASOUND NEEDLE FOR PORTAL VEIN SAMPLING IN A SWINE MODEL

Abstract

Endoscopic ultrasonography (EUS) guided sampling is considered as the gold standard for the diagnosis of suspected lesions of the gastrointestinal (GI) tract and adjacent structures. Rapid on-site cytological evaluation (ROSE) can enhance diagnostic yield, adequacy of sample acquisition, and thus decreasing the need for a repeat procedure. Data on its utility is unclear, especially at a community hospital, where utility may be further limited due to the unavailability of a GI pathologist. We aim to evaluate the evidence on the role of ROSE in the setting of EUS guided FNA and FNB in patients with a suspected lesion. We performed a retrospective chart review of 65 patients who had EUS guided FNA or FNB for suspected GI tract and adjacent structure lesions, with and without ROSE between August 2017 and August 2019 at Saint Agnes Medical Center. 40 patients were included in the study after excluding 25 patients based on inclusion criteria. The patient underwent EUS FNA and FNB samples were assessed with ROSE, and then pathologist performed the final interpretation. Final surgical pathology or clinico-radiological follow up was used as a gold standard. The institutional board review committee of our hospital approved the study. A total of 40 patients were included in this study, of which 22 underwent EUS-FNA, and 18 patients underwent EUS-FNB (Figure1). There were 23 female and 17 male patients with a mean age of 67 years. The mean size of the lesions was 27 mm. Lesions sampled were predominantly from the pancreas (18/40); other lesions included malignant appearing or enlarged lymph nodes (15/40), hepatic mass (5/40), and gastric mass (2/40). Out of a total of 40 cases included in this study, 19 patients had ROSE done during the procedure, and ROSE was not performed during the procedure of 21 patients (Figure 2). When ROSE was done during EUS FNA and FNB, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 80 %, 100 %, 100 %, 57%, and 84.2 %, respectively. When ROSE was not done during EUS FNA and FNB, sensitivity was 65 %. When comparing need to re-biopsy, it was needed in 2 out of total 21 patients in ROSE group (23.8%) and 5 out of 19 patients in group without ROSE (10.5%) with a p-value of <0.05. Mean number of passes to make the diagnosis and mean procedure duration was 3.9 vs. 2.5 (p < 0.05) and 48.5 mins vs 36.5 mins (p <0.05), between ROSE and without ROSE group respectively. In summary, our data suggested that EUS guided biopsy (FNA and FNB) with ROSE has significantly reduced the need for repeat biopsy. Although EUS guided biopsy (FNA and FNB) with ROSE added procedure time and the number of passes needed to make a diagnosis. Our findings advocate continued use of this resource at our hospital. The limitations of this study are that it was a retrospective, single-center study.