Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study

Abstract

Background and study aims Accurate diagnosis and classification of pancreatic cysts (PCs) remains a challenge. The aims of this study were to: (1) evaluate the safety and technical success of a novel microforceps for EUS-guided through-the-needle biopsy (TTNB) of PCs; and (2) assess its diagnostic yield for mucinous PCs when compared to FNA cyst fluid analysis and cytology. Patients and methods This was a multicenter retrospective analysis of 47 patients who underwent EUS-FNA and TTNB for PCs between January 2014 and June 2017. Technical success was defined as acquisition of a specimen adequate for cytologic or histological evaluation. Cyst fluid carcinoembryonic antigen (CEA) was used to initially categorize cysts as non-mucinous (CEA < 192 ng/mL) or mucinous (CEA ≥ 192 ng/mL). Final diagnosis was based on identifiable mucinous pancreatic cystic epithelium on cytology, microforceps histology and/or surgical histology when available. Results Forty-seven patients with PCs (mean size 30.7 mm) were included. TTNB was successfully performed in 46 of 47 (97.9 %). Technical success was significantly lower with FNA (48.9 %) compared to TTNB (85.1 %) ( P < .001). For cysts with insufficient amount of fluid for CEA (n = 19) or CEA < 192 ng/mL, the cumulative incremental diagnostic yield of a mucinous PC was significantly higher with TTNB vs. FNA (52.6 % vs 18.4 %; P = .004). TTNB alone (34.4 %) diagnosed more mucinous PCs than either CEA ≥ 192 ng/mL alone (6.3 %) or when combined with FNA cytology (9.4 %). One episode of self-limited bleeding (2.1 %) and one of pancreatitis (2.1 %) occurred. Conclusions EUS-TTNB is safe and effective for evaluating PCs. TTNB may help increase the diagnostic yield of mucinous PCs.

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

“…Full text review was subsequently performed on 51 studies using our predefined inclusion and exclusion criteria. Eight studies with a total of 426 cases were included in the final meta-analysis [21][22][23][24][25][26][27][28]. The study flow diagram is shown in ▶ Fig.…”

“…None of the studies were population based; with equal number of single center (n = 4) and multicenter (n = 4) studies. Three studies had > 50 patients [21,27,28], four studies included 30-49 patients [22,23,25,26], and one study < 30 patients [24]. Six out of the eight studies provided clear definitions on how a mucinous cyst was diagnosed [21,22,[25][26][27][28].…”

“…The microforceps can be advanced through the lumen of a standard 19gauge EUS-FNA needle for through-the-needle tissue biopsy (TTNB) of PCs. Since its introduction, there have been several studies reporting on the performance of the TTNB [16][17][18][19][20][21][22][23][24][25][26][27][28]. We performed a systematic review and meta-analysis of the current literature to better assess the feasibility, safety, and diagnostic yield of TTNB as compared to EUS-FNA in the evaluation of PCs.…”

Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

“…With the protocol of Crino ▶ et al, they reached 100 % histologic adequacy after two biopsy samples. Yang et al [19], performed three bites per pass for a total of three passes, obtaining a histologic sample in only 83 % of the cases.…”

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

“…Sensitivities for diagnosing mucinous cyst and malignant transformation using cyst fluid obtained by EUS‐FNA were not particularly high. Recently, EUS‐guided through‐the‐needle microforces biopsy was reported to improve the pathological yields and showed better diagnostic potential than that with EUS‐FNA . Further evaluation of this technique is required, as diagnostic yields might be limited considering possible patchy distribution of specific pathological findings for differential diagnosis on the cyst wall.…”