Endoscopic ultrasonography‐fine needle aspiration of solid pancreatic masses: Do we need the fourth pass? A prospective study

Abstract

Background Endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA) is important for the differential diagnosis of solid pancreatic lesions. Sample adequacy is related to the number of needle passes, and European guidelines recommend three to four needle passes with a standard EUS‐FNA needle. We aimed to evaluate the optimal number of passes with standard EUS‐FNA needles in solid pancreatic lesions. Methods Patients with solid pancreatic masses without cystic component >20% on computed tomography scan, and without biliary metallic stents, or coagulation problems were included prospectively. Standard 22G needles were used (maximum four passes); each sample was paraffin‐embedded and analyzed separately. Final diagnosis was established by EUS‐FNA, repeat EUS‐FNA, surgery, or follow‐up. Results Sixty‐one of 65 patients were included. The final diagnoses were adenocarcinoma (n = 44, 72%), neuroendocrine tumor (NET) (n = 10, 16%), metastasis (n = 1, 4%) and nonmalignant lesion (n = 6, 10%). Immunohistochemical staining was possible in 17 cases. The diagnosis was established by the first pass in 62% of cases (n = 38), by the second in 15% (n = 9), by the third in 15% (n = 9), and by the fourth in 3% (n = 2). The diagnostic accuracy for all four passes compared to the first three passes was 95% vs 92% (P = .5). The contribution of the fourth pass was not different between adenocarcinoma and NET (2% vs 10%, respectively; P = .667). Conclusion Three passes with standard EUS‐FNA was optimal for a specific diagnosis of solid pancreatic masses, regardless of the histological type of the lesion.

The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions

“…Additional punctures reportedly improve the sensitivity when initial EUS-TA is inconclusive. Several studies have investigated the optimal number of passes for the diagnosis of SPLs, with t improvements in the sensitivity of EUS-TA reaching a plateau after the third or fourth puncture, regardless of tumor localization or size [51][52][53][54]. Therefore, other examinations should be considered if the diagnosis is inconclusive even after the third or fourth puncture.…”

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

“…The initial search identified a total of 753 publications and after screening for eligibility, 33 studies with 6883 cases 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 were included in the analysis: eight prospective studies and 25 retrospective studies (Figure 1 ). The study characteristics are summarized in Table 1 , and the results of our meta‐analysis are summarized in Table 2 .…”