Diagnostic yield of endoscopic ultrasound-guided tissue acquisition for small solid pancreatic lesions

Mie, Takafumi; Sasaki, Takashi; Kanata, Ryo; Furukawa, Takaaki; Takeda, Tsuyoshi; Kasuga, Akiyoshi; Ozaka, Masato; Sasahira, Naoki

doi:10.1055/a-1230-3555

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Therefore, the 90% accuracy we found in our study seems significantly better, even if we used a smallercaliber needle (25-gauge) in 65% of cases. In the paper by Mie et al [28], Franseen needles were compared to 22-gauge FNA needles and 20-gauge forward-bevel needles in small (<20 mm) SPLs. The accuracy of the Franseen needle was 86%, significantly lower when compared to 93% obtained with FNA needles and 97% obtained with the forward-bevel FNB needle, postulating the unsuitability of the "three-cutting surfaces" tip needle for the evaluation of small SPLs.…”

Section: Discussionmentioning

confidence: 99%

EUS-FNA versus EUS-FNB in Pancreatic Solid Lesions ≤ 15 mm

Conti Bellocchi,

Bernuzzi,

Brillo

et al. 2024

Diagnostics

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A small tumor size may impact the diagnostic performance of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing solid pancreatic lesions (SPLs). We aimed to compare the diagnostic yield of EUS-guided fine-needle aspiration (FNA) and biopsy (FNB) in SPLs with a diameter ≤ 15 mm. Consecutive patients who underwent EUS-TA for SPLs ≤ 15 mm between January 2015 and December 2022 in a tertiary referral center were retrospectively evaluated. The primary endpoint was diagnostic accuracy. The final diagnosis was based on surgical pathology or disease evolution after a minimum follow-up of 6 months. Inadequate samples were all considered false negatives for the study. Secondary outcomes included sample adequacy, factors impacting accuracy, and safety. We included 368 patients (52.4% male; mean age: 60.2 years) who underwent FNA in 72 cases and FNB in 296. The mean size of SPLs was 11.9 ± 2.6 mm. More than three passes were performed in 5.7% and 61.5% of patients in the FNB and FNA groups, respectively (p < 0.0001). FNB outperformed FNA in terms of diagnostic accuracy (89.8% vs. 79.1%, p = 0.013) and sample adequacy (95.9% vs. 86.1%, p < 0.001). On multivariate analysis, using FNA (OR: 2.10, 95% CI: 1.07–4.48) and a final diagnosis (OR: 3.56, 95% CI: 1.82–6.94) of benign conditions negatively impacted accuracy. Overall, the adverse event rate was 0.8%, including one pancreatitis in the FNA group and one pancreatitis and one bleeding in the FNB group, all mild and conservatively managed. EUS-TA for SPLs ≤ 15 mm has a high diagnostic yield and safety. This study suggests the superiority of FNB over FNA, with better performance even with fewer passes performed.

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Section: Discussionmentioning

confidence: 99%

EUS-FNA versus EUS-FNB in Pancreatic Solid Lesions ≤ 15 mm

Conti Bellocchi,

Bernuzzi,

Brillo

et al. 2024

Diagnostics

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“…In such scenarios, cytology via EUS-FNA with ROSE may offer greater utility. Mie et al reported a study demonstrating the high diagnostic yield and safety of EUS-guided tissue acquisition for ROSE from small, solid pancreatic lesions [ 60 ]. Fitzpatrick et al reported the diagnostic performance of cytopathology (CP) in assessing pancreatic EUS-FNB specimens, examined FNB performance based on tissue triage, and reviewed different specimen types [ 61 ].…”

Section: Improvements To Current Diagnostic Approachesmentioning

confidence: 99%

Advances in the Early Diagnosis of Pancreatic Ductal Adenocarcinoma and Premalignant Pancreatic Lesions

et al. 2023

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Pancreatic cancer is one of the most lethal human malignancies, in part because it is often diagnosed at late stages when surgery and systemic therapies are either unfeasible or ineffective. Therefore, diagnosing pancreatic cancer in earlier stages is important for effective treatment. However, because the signs and symptoms may be nonspecific and not apparent until the disease is at a late stage, the timely diagnoses of pancreatic cancer can be difficult to achieve. Recent studies have shown that selective screening and increased usage of biomarkers could improve the early diagnosis of pancreatic cancer. In this review, we discuss recent advancements in the early detection of pancreatic ductal carcinoma and precancerous lesions. These include innovations in imaging modalities, the diagnostic utility of various biomarkers, biopsy techniques, and population-based surveillance approaches. Additionally, we discuss how machine learning methods are being applied to develop integrated methods of identifying individuals at high risk of developing pancreatic disease. In the future, the overall survival of pancreatic cancer patients could be improved by the development and adoption of these new methods and techniques.

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“…However, as described above, in our meta‐analysis, neither EUS‐FNB nor slow pull method appeared to increase sensitivity of EUS‐TA for small SPLs but recently various FNB needles with different designs and sizes are commercially available. Mie et al 48 retrospectively compared three needles (22‐gauge FNA needle, 20‐gauge forward‐bevel FNB needle, and 22‐gauge Franseen needle) in small (<20 mm) SPLs and found the accuracy of the Franseen needle was 85.7%, compared to 92.7% with the FNA needle and 97.0% with the forward bevel FNB needle ( p = 0.10). They speculated the Franseen geometry might make the needle puncture of small SPLs difficult, rather than the sharp tip of the other two needles.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasonography‐guided tissue acquisition for small solid pancreatic lesions: Does the size matter?

et al. 2021

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Endoscopic ultrasonography‐guided tissue acquisition (EUS‐TA) is now an established technique to obtain the pathological diagnosis of solid pancreatic lesions (SPLs), but the diagnosis of small SPLS by EUS‐TA can still be difficult. We conducted a literature review and a meta‐analysis on the diagnostic yield of EUS‐TA according to the tumor size. In a meta‐analysis of 33 studies with 6883 cases, a pooled odds ratio (OR) of sensitivity was significantly higher in SPLs of >20 mm (OR 1.64, p = 0.02) and in SPLs of >10 mm (OR 3.05, p = 0.01), but not in SPLs of >30 mm (OR 1.18, p = 0.46). The meta‐analysis of accuracy also showed a similar trend: OR of 1.59 in SPLs of >20 mm ( p < 0.01) and OR of 3.27 in SPLs of >10 mm ( p < 0.01) and OR of 1.03 in SPLs of >30 mm ( p = 0.87). The use of a 25‐gauge needle tended to improve sensitivity in small SPLs, though not statistically significant: OR of 1.25 and 2.82 in studies with and without a 25‐gauge needle ( p = 0.08). The use of fine needle biopsy needles, slow pull method, and rapid on‐site evaluation did not significantly improve sensitivity in small SPLs. EUS‐TA for small SPLs, especially neuroendocrine neoplasms, is reported to have a high risk of adverse events. In summary, the diagnostic yield and safety of EUS‐TA for small (<20 mm) SPLs still needs improvement, and the best needle and technique for small SPLs should be further investigated.

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Diagnostic yield of endoscopic ultrasound-guided tissue acquisition for small solid pancreatic lesions

Cited by 6 publications

References 21 publications

EUS-FNA versus EUS-FNB in Pancreatic Solid Lesions ≤ 15 mm

EUS-FNA versus EUS-FNB in Pancreatic Solid Lesions ≤ 15 mm

Advances in the Early Diagnosis of Pancreatic Ductal Adenocarcinoma and Premalignant Pancreatic Lesions

Endoscopic ultrasonography‐guided tissue acquisition for small solid pancreatic lesions: Does the size matter?

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