Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis

Abstract

Background/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling. Methods: This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events. Results: A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15-23.08; p=0.032). No adverse events were reported in either cohort. Conclusions: Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses. Clin Endosc 2019 Dec 3. [Epub ahead of print]

Endoscopic Ultrasound Fine-Needle Biopsy May Contribute to the Diagnosis of Malignant Lymph Nodes

“…No statistically significant difference was observed between the accuracy of FNA + ROSE and the accuracy of FNB alone (94.4% vs. 80.7%, p= 0.161). 1 Although this result should be interpreted with caution, especially since only 17.2% of the study population underwent additional testing with ROSE according to the author, the results largely support the useful contribution of EUS-FNB in clinical practice. 1 The authors noted several limitations of their study, including the study design (retrospective design and lack of randomization), selection bias, including different needle sizes, and the possibility that patients were lost to follow-up.…”

“…1 Although this result should be interpreted with caution, especially since only 17.2% of the study population underwent additional testing with ROSE according to the author, the results largely support the useful contribution of EUS-FNB in clinical practice. 1 The authors noted several limitations of their study, including the study design (retrospective design and lack of randomization), selection bias, including different needle sizes, and the possibility that patients were lost to follow-up. However, despite these limitations, this study might shed more light on the difficulties encountered when diagnosing the LNs in clinical practice because this study was the largest multicenter study that specifically compared the effectiveness and safety of EUS-FNA and EUS-FNB for LN sampling.…”

“…The specificity of FNB was better than that of FNA (100.0% vs. 93.6%, p= 0.01). 1 Although significant differences were not observed in the diagnostic yields, it was suggested that FNB may have a better clinical effect than FNA.…”

“…We would like to comment on a multicenter retrospective study of prospectively collected data for evaluating the outcomes of endoscopic ultrasound fine-needle aspiration (EUS-FNA) and endoscopic ultrasound fine-needle biopsy (EUS-FNB) for lymph node (LN) sampling authored by de Moura et al 1 The treatment strategy and disease prognosis are markedly affected by whether lymphadenopathy is malignant or benign. EUS and EUS-guided sampling are well-known as suitable examination methods for assessing lymphadenopathy.…”

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

“…The safety of EUS-tissue sampling is well established and few AEs are encountered in the literature. Severe adverse events are especially rare [6,23,28,33]. The safety profile of FNB was comparable to that of FNA, with only one AE encountered in the entire cohortthough this resulted in the patient's death.…”