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

Abstract

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.

New Era of Endoscopic Ultrasound-Guided Tissue Acquisition: Next-Generation Sequencing by Endoscopic Ultrasound-Guided Sampling for Pancreatic Cancer

“…No prospective trials have evaluated the adequacy of EUS-TA samples for NGS, but several retrospective studies have reported that the adequacy of EUS-TA samples for NGS ranged from 60% to 100% [78,79,80,81] (Table 1).…”

Evaluation of endoscopic ultrasound fine-needle aspiration versus fine-needle biopsy and impact of rapid on-site evaluation for pancreatic masses

“…However, several studies have shown that FNB is associated with better results compared to FNA in several types of pancreatic lesions. Elhanafi et al showed that FNB should be considered when pancreatic adenocarcinoma genotyping is requested, especially for tumors smaller than 3 cm located in the head/neck of the pancreas [34]. In a retrospective study including 91 patients over a 13-year period evaluating FNA and FNB in neuroendocrine pancreatic tumors, FNB was found to improve diagnostic sensitivity and conferred additional information to cytological assessment [35].…”

EUS tissue acquisition: From A to B

“…Larson et al observed no difference between the two needle types,[ 77 ] but in a larger trial by Elhanafi et al including 167 patients, the proportion of samples sufficient for NGS was higher in the FNB group. [ 78 ] However, both the abovementioned studies are retrospective in design, and prospective comparative studies are lacking.…”