AGA White Paper: Optimizing Endoscopic Ultrasound–Guided Tissue Acquisition and Future Directions

Wani, Sachin; Muthusamy, V. Raman; McGrath, Cindy; Sepulveda, Antonia R.; Das, Ananya; Messersmith, Wells A.; Kochman, Michael L.; Shah, Janak N.

doi:10.1016/j.cgh.2017.10.020

Cited by 76 publications

(74 citation statements)

References 78 publications

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“…Two recent white papers have highlighted the need to investigate methods of EUS‐TA for optimal DNA recovery and characterization of pancreatic cancer tissue as molecular tissue analysis becomes increasingly relevant to clinical care . In this study, we found that EUS‐FNB was more likely to result in sufficient tissue sampling for genomic testing compared with EUS‐FNA in patients with PDAC.…”

Section: Discussionmentioning

confidence: 68%

“…Next‐generation sequencing (NGS) has enabled disease‐targeted gene panels, whole‐exome, or whole‐genome sequencing of specimens with relatively low DNA input in a cost‐efficient and timely manner . However, it is estimated that less than 10% of registered drug intervention trials for pancreatic adenocarcinoma have included a molecular/biomarker stratification strategy .…”

Section: Introductionmentioning

confidence: 99%

“…Next-generation sequencing (NGS) has enabled disease-targeted gene panels, whole-exome, or whole-genome sequencing of specimens with relatively low DNA input in a cost-efficient and timely manner. 3 However, it is estimated that less than 10% of registered drug intervention trials for pancreatic adenocarcinoma have included a molecular/biomarker stratification strategy. 4 Obtaining adequate and high-quality tumor material is essential for genomic profiling, and the role of EUS-FNA versus FNB for obtaining sufficient tissue for tumor genotyping for pancreatic cancer remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer

Elhanafi

Mahmud

Vergara

et al. 2018

J of Gastro and Hepatol

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Background and Aim Tumor genotyping may allow for improved prognostication and targeted therapy for pancreatic ductal adenocarcinoma (PDAC). We aimed to compare endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) to fine needle biopsy (FNB) for obtaining sufficient tissue for genomic analysis and theranostic potential. Methods A retrospective cohort study of patients that underwent EUS‐FNA or EUS‐FNB with either positive or suspicious cytology for PDAC between March 2016 and December 2017. Demographic, procedural, and cytology data were recorded. Genetic alterations were recorded, and Kaplan–Meier survival curves were calculated. Results The study included 167 patients: 145 patients had FNA and 22 patients underwent FNB. Overall, 117 samples (70.1%) were sufficient for targeted next‐generation sequencing. FNB resulted in a higher proportion of patients with sufficient samples compared with FNA (90.9% vs 66.9%; P = 0.02). In multivariable modeling, only FNB (odds ratio 4.95, 95% confidence interval 1.11–22.05, P = 0.04) was associated with sufficient sampling for genomic testing. FNB was more likely to obtain sufficient tissue from tumors ≤ 3 cm (100% vs 68.4%, P = 0.017) and tumors located in the head/neck of the pancreas (100% vs 63.1%, P = 0.03) compared with FNA. The most commonly identified alterations were in KRAS (88%), TP53 (68%), and SMAD4 (16%). Conclusions Endoscopic ultrasonography can reliably obtain sufficient tissue from PDAC for targeted genomic sequencing for prognostication and theranostics. FNB should be considered when tumor genotyping is requested, especially for tumors ≤ 3 cm or tumors located in the head/neck of the pancreas.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer

Elhanafi

Mahmud

Vergara

et al. 2018

J of Gastro and Hepatol

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“…PDACs demonstrate only 5 % to 20 % neoplastic cellularity and are characterized by a prominent desmoplastic reaction considered to be a hostile tumor microenvironment (TME) for subsequent therapy 11 12 . Cytology smears are thought to be superior for multiplex gene panel NGS evaluations, as their overall cellularity, tumor fraction, and sequencing metrics are considered to be superior to that of FNB, yet, successful preclinical disease models to include organoid development require that EUS-FNB deliver tumor cells and the corresponding TME 13 14 15 . …”

Section: Discussionmentioning

confidence: 99%

EUS fine-needle pancreatic core biopsy can determine eligibility for tumor-agnostic immunotherapy

et al. 2018

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Background and study aims The US FDA recently approved a cancer treatment with pembrolizumab based upon the tumor biomarker status of deficient mismatch repair (dMMR) rather than a specific disease-based approach. We sought to determine if endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) could determine dMMR and quantification of PD-L1 expression to potentially guide the delivery of tumor agnostic immunotherapy. Patients and methods Immunohistochemistry was performed on archived pancreas core biopsy specimens. Tumors with absent nuclear staining of DNA mismatch repair proteins represented dMMR. Tumors were considered to have any or high PD-L1 expression, if expressed in ≥ 1 % or ≥ 50 % of tumor cells. Results Histologic specimen adequacy for MMR status assessment was satisfactory in 97.2 % of tumors. dMMR and high PD-L1 expression was identified in 3 % and 8.1 % of the cohort. Conclusion In the setting of tumor type agnostic immunotherapy, it is projected that at least 3 % of malignant pancreas lesions will be sensitive to pembrolizumab and up to 8 % sensitive to the family of immune checkpoint inhibitors. This highlights the expanding role of EUS-FNB in the field of precision immuno-oncology.

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“…A meta‐analysis of nine studies showed no significant differences between the 22‐G ProCore and the standard 22‐G FNA needles in diagnostic adequacy, accuracy, or histological core specimen acquisition . Recently, other types of needle, specifically conceived for EUS‐FNB, have become available . Encouraging results were reported with diagnostic accuracy >90% with the use of the 20‐G ProCore needle (Cook Medical) with a forward‐facing bevel and a Menghini tip; the SharkCore needle (Medtronic Corporation, Newton, MA, USA) which is a fork‐tip needle with two cutting edges; and with the Acquire needle (Boston Scientific Corporation, Natick, MA, USA) with a Franseen tip geometry with three cutting edges.…”

Section: Interventional Eus: New Tools New (And Old) Applicationsmentioning

confidence: 99%

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Tontini

Manfredi

Orlando

et al. 2019

Digestive Endoscopy

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Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.

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AGA White Paper: Optimizing Endoscopic Ultrasound–Guided Tissue Acquisition and Future Directions

Cited by 76 publications

References 78 publications

Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer

Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer

EUS fine-needle pancreatic core biopsy can determine eligibility for tumor-agnostic immunotherapy

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

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