Endoscopic ultrasound guided fine‐needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency

Abstract

Background: Endoscopic ultrasound (EUS) guided core needle biopsies (CNB) are increasingly being performed to diagnose solid pancreatic lesions. However, studies have been conflicting in terms of CNB improving diagnostic accuracy and procedural efficiency vs fine-needle aspiration (FNA), which this study aims to elucidate.Methods: Data were prospectively collected on consecutive patients with solid pancreatic or peripancreatic lesions at a single tertiary care center from November 2015 to November 2016 that underwent either FNA or CNB. Patient demographics, characteristics of lesions, diagnostic accuracy, final and follow-up pathology, use of rapid on-site evaluation (ROSE), complications, and procedure variables were obtained.Results: A total of 75 FNA and 48 CNB were performed; of these, 13 patients had both. Mean passes were lower with CNB compared to FNA (2.4 vs 2.9, P = .02). Use of ROSE was higher for FNA (97.3% vs 68.1%, P = .001). Mean procedure time was shorter with CNB (34.1 minutes vs 51.2 minutes, P = .02) and diagnostic accuracy was similar (89.2% vs 89.4%, P = .98). There was no difference in diagnostic accuracy when ROSE was performed for CNB vs not performed (93.5% vs 85.7%, P = .58).Additionally, diagnostic accuracy of combined FNA and CNB procedures was 92.3%, which was comparable to FNA (P = .73) or CNB (P = .52) alone.Conclusion: FNA and CNB had comparable safety and diagnostic accuracy. Use of CNB resulted in less number of passes and shorter procedure time as compared to FNA. Moreover, diagnostic accuracy for CNB with or without ROSE was similar.K E Y W O R D S core biopsy, endoscopic ultrasound, fine-needle aspiration, pancreatic cancer, pancreatic mass

Comparison of EUS-guided conventional smear and liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

“…EUS-FNB needles, on the other hand, allow sampling of a larger amount of tissue and better preservation of cell architecture than an aspirate. Several studies have shown comparable diagnostic accuracy of EUS-FNA and EUS-FNB in solid pancreatic lesions, with the exception of fewer needle passes needed to obtain an adequate sample using the EUS-FNB technique 8 9 10 11 . Recently Sweeney et al also showed comparable diagnostic yield of EUS-FNA, FNB, and combined FNA and FNB in solid pancreatic lesions 12 .…”

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

“…A combination of cytology and histology would give 85% accuracy with EUS‐FNA for solid pancreatic lesions (75.4%‐94.8% based on cytology and 68.9%‐89.3% based on histology alone), 6 with better outcomes with histology alone for those tumors that are not adenocarcinomas 18 . One report showed that the combination of cytology with core histology gave the same results as core histology alone 19 . However, other technical factors influence the diagnosis: for example, fanning with three passes using cytology and core histology assessment obtained better accuracy compared with conventional sampling (94% vs 77%) 11 .…”

A Meta-Analysis Comparing Endoscopic Ultrasound-guided Fine-needle Aspiration With Endoscopic Ultrasound-guided Fine-needle Biopsy

“…The included period ranged from 2012 to 2021. Eleven RCTs 13,[15][16][17][19][20][21]24,[26][27][28] were parallel trials and 7 14,18,22,23,25,29,30 were cross-over studies. Six RCTs were conducted in Asia 14,15,19,20,23,24 and all studies presented 2 well balanced arms regarding lesion features (location and size) and clinical demographical characteristics.…”