EUS-guided reverse bevel fine-needle biopsy sampling and open tip fine-needle aspiration in solid pancreatic lesions – a prospective, comparative study

Hedenström, Per; Demir, Akif; Khodakaram, Kaveh; Nilsson, Ola; Sadik, Riadh

doi:10.1080/00365521.2017.1421704

Cited by 23 publications

(21 citation statements)

References 31 publications

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“…In the study by Witt et al the Sharkcore needles achieved a 90 % diagnostic sensitivity with significantly fewer mean number of needle passes compared to EUS-FNA sampling, although the study included only 20 patients 20 . Our results confirm the high diagnostic yield of the EUS-FNB devices (85.4 %) for PanNET sampling, and also confirm that the combination of both FNA and FNB modalities may be helpful in selected patients, such as cases suspicious for PanNETs, to achieve a correct diagnoses 39 .…”

Section: Discussionsupporting

confidence: 83%

Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors

et al. 2019

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ABSTR AC T Background and study aims Endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA) as a method of obtaining preoperative diagnosis of pancreatic neuroendocrine tumors (PanNETs) has been reported in several series. Fine-needle biopsies (FNB) are increasingly employed to obtain core specimens during EUS. However, the differences in efficacy between these sampling methods in the diagnosis of PanNETs still needs to be defined.Patients and methods Over a 13-year period, all patients who underwent EUS-guided tissue sampling of suspicious pancreatic lesions with clinical, endoscopic and pathologic details were entered into an electronic database. Lesions underwent EUS-FNA or FNB sampling, or a combination of the two. The accuracy and safety of different EUS-guided sampling methods for confirmed PanNETs were investigated. ResultsA total of 91 patients (M/F: 42/49, median age: 57 years), who underwent 102 EUS procedures had a final diagnosis of PanNET. Both EUS-guided sampling modalities were used in 28 procedures, EUS-FNA alone was used in 61 cases, while EUS-FNB alone in 13 cases. Diagnostic yield of EUS-FNA and EUS-FNB alone, including the inadequate specimens, was 77.5 % (95 %CI: 68.9 -86.2 %) and 85.4 % (95 % CI: 74.6 -96.2 %), respectively. The combination of both sampling modalities established the diagnosis in 96.4 % of cases (27/28) (95 %CI: 89.6 -100 %), significantly superior to EUS-FNA alone (P = 0.023). Diagnostic sensitivity among the adequate samples for EUS-FNA, EUS-FNB and for the combination of the two methods was 88.4 % (95 %CI: 80.9 -96.0 %), 94.3 % (95 %CI: 86.6 -100 %) and 100 % (95 % CI: 100 -100 %). There was one reported complication, a post-FNA bleeding, treated conservatively.Conclusions EUS-FNB improves diagnostic sensitivity and confers additional information to cytological assessment of PanNETs.▶ Table 1 Patient, lesion and sampling characteristics. Characteristics ▪ Gender (M/F) 42/49 ▪ Age, years (range) 57 (26 -87) ▪ Size of lesion, median mm (range) 18 (7 -59) Lesion diameter, group ▪ ≤ 10 mm 27 (26.5 %) ▪ > 10 mm and ≤ 20 mm 33 (32.3 %) ▪ > 20 mm 42 (41.2 %) Lesion location, n (%) ▪ Pancreatic head 34 (33.3 %) ▪ Pancreatic body 47 (46.1 %) ▪ Pancreatic tail 21 (20.6 %) Sampling technique ▪ FNA alone 61 (59.8 %) ▪ FNB alone 13 (12.7 %) ▪ FNA + FNB 28 (27.5 %)FNA, fine-needle aspiration; FNB, fine-needle biopsy

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Section: Discussionsupporting

confidence: 83%

Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors

et al. 2019

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“…Even though Eusebi and co-workers present valuable new data, it remains to be decided to what extent EUS-FNB may be superior to EUS-FNA in the work-up of suspected PanNETs. This study, like others 21 , shows that EUS-FNB is a useful adjunct to EUS-FNA. Whether EUS-FNB should be used as the primary technique, or as a rescue technique after an unsuccessful EUS-FNA, warrants further investigation.…”

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confidence: 85%

“…Whether EUS-FNB should be used as the primary technique, or as a rescue technique after an unsuccessful EUS-FNA, warrants further investigation. Studies analyzing the benefit of combining a 25-gauge FNA needle and a 22-gauge reverse bevel FNB needle in the same solid pancreatic lesion have shown contradictory results 21 22 . Moreover, such an approach implicates increased costs and a prolonged procedural time.…”

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confidence: 99%

The best approach for sampling of pancreatic neuroendocrine tumors – EUS-FNA or EUS-FNB?

Hedenström

2019

Endosc Int Open

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“…EUS-FNAB has higher specificity and sensitivity for the differential diagnosis of pancreatic mass than traditional imaging techniques, and it has now been utilized extensively [45][46][47][48]. It was the use of EUS-FNAB that prevented the application of unnecessary surgery.…”

Section: Discussionmentioning

confidence: 99%

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

Yu¹,

Li²,

Gong

et al. 2020

BMC Gastroenterol

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Background: Left-sided portal hypertension (LSPH) is an extremely rare clinical syndrome, and it is the only form of curable portal hypertension. It is primarily caused by pancreatic disease, and is associated with complications that cause spleen vein compression. Specific symptoms are often lacking, rendering it difficult to diagnose. Splenectomy is the main treatment for cases complicated by variceal bleeding, and the effects of treatment primarily depend on the condition of the primary disease. Case presentation: The patient was a 29-year-old woman who was admitted to the hospital for repeated hematemesis and black stool. She had been misdiagnosed with pancreatic cancer 7 years prior. Combined imaging and endoscopic examination indicated varicose gastric fundus veins, a pancreatic mass, and enlarged peripancreatic lymph nodes. Laboratory investigations revealed reduced erythrocyte, platelet, and leukocyte counts, the interferon gamma release assay was positive, and liver function was normal. Abdominal exploration, splenectomy, varicose vein dissection, and lesion resection were performed via laparotomy. Postoperative biopsy analysis confirmed the diagnosis of lymph node tuberculosis. Based on the above-described factors, LSPH caused by peripancreatic lymph node tuberculosis was a diagnosed. Conclusions: Herein we describe the first reported case of LSPH caused by peripancreatic lymph node tuberculosis. When left portal hypertension occurs simultaneously, peripancreatic lymph node tuberculosis is often misdiagnosed as pancreatic cancer. Further studies are necessary to develop a more favorable diagnostic method for pancreas masses and more advantageous therapy for LSPH, especially in cases caused by mechanical compression.

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EUS-guided reverse bevel fine-needle biopsy sampling and open tip fine-needle aspiration in solid pancreatic lesions – a prospective, comparative study

Cited by 23 publications

References 31 publications

Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors

Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors

The best approach for sampling of pancreatic neuroendocrine tumors – EUS-FNA or EUS-FNB?

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review

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