Endoscopic ultrasound-guided histological diagnosis of a mucinous non-neoplastic pancreatic cyst using a specially designed through-the-needle microforceps

Attili, Fabia; Pagliari, Danilo; Rimbaș, Mihai; Inzani, Frediano; Brizi, Maria Gabriella; Costamagna, Guido; Larghi, Alberto

doi:10.1055/s-0042-108194

Cited by 22 publications

(21 citation statements)

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“…# 240, Yokneam 2069204, Israel) through a 19-gauge EUS needle in two patients with pancreatic cystic lesions. 20 Since then, several case reports have been published using different micro-forceps for a total of 14 cases described [21][22][23][24][25][26][27] and, recently, a small, single center, retrospective study. 28 .…”

Section: Discussionmentioning

confidence: 99%

“…In most of these articles the Moray micro-forceps was used, as in our series. [23][24][25][26][27][28] We carried out EUS-TTNB in unilocular and oligolocular PCL not clearly communicating with the main pancreatic duct in patients with worrisome features, in accordance with IAP (International Association of Pancreatology) guidelines, or in PCL with dimensional growth. In all cases, we were able to push the Moray forceps through the needle into the cyst and obtain a cystic wall biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Intracystic CEA level was considered suspicious for a mucinous PCL when ≥192 ng/mL, for a serous cystoadenoma when ≤5 ng/mL, and not diagnostic when between 6 and 191 ng/mL. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]…”

Section: Ethics and Populationmentioning

confidence: 99%

“…Since 2010, several case reports using different micro‐forceps working through a 19‐gauge EUS needle, and a recently published, small, single‐center, retrospective study, have shown encouraging results on the possibility of sampling of PCL cystic walls.…”

Section: Introductionmentioning

confidence: 99%

“…Direct sampling of the cystic wall with different devices has shown better results. [15][16][17][18][19] Since 2010, several case reports [20][21][22][23][24][25][26][27] using different micro-forceps working through a 19-gauge EUS needle, and a recently published, small, single-center, retrospective study, 28 have shown encouraging results on the possibility of sampling of PCL cystic walls.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ultrasound‐through‐the‐needle biopsy in pancreatic cystic lesions: A multicenter study

Barresi

Crinò

Fabbri

et al. 2018

Digestive Endoscopy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Ethics and Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Endoscopic ultrasound‐through‐the‐needle biopsy in pancreatic cystic lesions: A multicenter study

Barresi

Crinò

Fabbri

et al. 2018

Digestive Endoscopy

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Nondiagnostic fine‐needle aspirates of the pancreas: A root cause analysis

Gokozan

Michael

2020

Cancer Cytopathology

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BACKGROUND: Fine-needle aspiration (FNA) of the pancreas is considered the primary and least invasive diagnostic method in the evaluation of pancreatic lesions. A nondiagnostic sample may trigger repeat FNA or a more invasive diagnostic procedure. The goal of this study was to identify the root causes of nondiagnostic samples. METHODS: We performed a retrospective review of FNAs of the pancreas categorized as nondiagnostic at our institution between 2008 and 2019. Medical records and slides were reviewed to identify the features described by imaging, rapid on-site evaluation, fluid chemistry, final cytology diagnosis, and final histology. A root cause analysis was performed using the Ishikawa (or fishbone) diagram and the 5 Whys method. RESULTS: A total of 30 cases were identified: 11 adenocarcinomas, 6 cases of pancreatitis, 4 intraductal papillary mucinous neoplasms, 3 serous cystadenomas, 3 neuroendocrine tumors, 1 mucinous cystic neoplasm, 1 retention cyst, and 1 case of Brunner gland hyperplasia. The root causes identified were: man in 8 cases, machine in 1 case, method in 17 cases, and material in 18 cases. In many cases, more than 1 root cause contributed to the problem. CONCLUSION: Material related errors contributed to the majority of nondiagnostic results and were primarily related to fibrotic cancers, chronic pancreatitis, absence of diagnostic criteria of cystic lesions, and technically challenging cases. Only 1 major interpretation error was identified. Sampling and interpretive errors contributed equally to man-related causes. For mucinous cysts, neoplastic mucin was difficult to identify in liquid-based preparations. Pathologists tended to issue a nondiagnostic categorization when epithelial cells are lacking and particularly when the nature and radiological impression of the cyst was not communicated.

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A new micro‐forceps for endoscopic ultrasound‐guided through‐the‐needle biopsy in the diagnosis of pancreatic cystic lesions: Single center experience

2021

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Background and Aim Endoscopic ultrasound (EUS)‐guided through‐the‐needle biopsy (TTNB) has improved the diagnostic algorithm of pancreatic cystic neoplasms (PCNs). Recently, a new through‐the‐needle micro‐forceps device (Micro Bite, MTW Endoskopie Manufakture) has been introduced. The primary aim was to assess the safety and technical success of this new type of micro‐forceps. The secondary aim was to evaluate the diagnostic role of EUS‐TTNB. Methods Retrospective study of consecutive patients receiving EUS‐TTNB for the diagnosis of PCNs. Two micro‐forceps were used: Moray Micro‐forceps and Micro‐Bite. Cystic fluid was collected for cytological analysis. Categorical variables were analyzed by Fisher's exact test, and continuous variables were analyzed by Student's t‐test. P < 0.05 was considered significant. Results Forty‐nine patients enrolled in the study (24% male; mean age 63 ± 14 years). TTNB was successfully performed in all patients. A diagnostic sample was obtained in 67.3% PCNs with TTNB compared with 36.7% with cyst fluid cytology (P 0.01). Adverse events rate was 10.2% and occurred in older patients (76.6 ± 5.4 vs 61.3 ± 13.7 P = 0.02). The 51% underwent EUS‐TTNB with Micro Bite. A diagnostic sample was obtained in 52% PCNs with Micro Bite compared with 24% obtained with cyst fluid cytology (P = 0.07). Comparing the two devices, the rate of diagnostic sample obtained with the micro‐forceps Moray was higher than that obtained with the Micro Bite (20/24 [83.3%] vs 13/25 [52%] P 0.03). Conclusions EUS‐TTNB increases the diagnostic yield of PCNs. The new Micro‐Bite could represent a valid alternative to the currently used Moray Micro‐forceps, but its diagnostic rate is still suboptimal and further studies are needed.

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Endoscopic ultrasound-guided histological diagnosis of a mucinous non-neoplastic pancreatic cyst using a specially designed through-the-needle microforceps

Cited by 22 publications

References 4 publications

Endoscopic ultrasound‐through‐the‐needle biopsy in pancreatic cystic lesions: A multicenter study

Endoscopic ultrasound‐through‐the‐needle biopsy in pancreatic cystic lesions: A multicenter study

Nondiagnostic fine‐needle aspirates of the pancreas: A root cause analysis

A new micro‐forceps for endoscopic ultrasound‐guided through‐the‐needle biopsy in the diagnosis of pancreatic cystic lesions: Single center experience

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