Predictors of adverse events after endoscopic ultrasound-guided through-the-needle biopsy of pancreatic cysts: a recursive partitioning analysis

Abstract

Background and study aims Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNB-related AEs and to generate a prognostic model using recursive partitioning analysis (RPA). Patients and methods Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. Results Mean cysts size was 36.7mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45%), serous cystadenoma (18.8%), and mucinous cystadenoma (12.8%). Fifty-eight (11.5%) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p=0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p=0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p<0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28% AEs rate), low-risk (1.4% AE rate, including patients <64 years with other-than-IPMN diagnosis sampled with ≤2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1% AEs rate, including the remaining patients). Conclusion TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.

Needle Tract Seeding after Endoscopic Ultrasound Tissue Acquisition of Pancreatic Lesions: A Systematic Review and Meta-Analysis

“…While EUS-FNA may still play a competitive role as compared to EUS-FNB when rapid-on-site cytological evaluation (ROSE) is available, EUS-FNB was found to overperform standard FNA for tissue sampling of several solid lesions in the absence of a pathologist in the endoscopic room [ 3 , 4 , 5 , 6 ]. Moreover, in spite of the favorable diagnostic outcomes of EUS through-the-needle biopsy (TTNB) and confocal laser endomicroscopy (CLE), EUS-FNA is still frequently used in the diagnostic algorithm of cystic pancreatic lesions (PCLs) [ 7 , 8 , 9 ]. Although uncommon, one potential and serious complication of EUS-TA is needle tract seeding (NTS) [ 10 ].…”

Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

“…In the cystic neoplasm, such as our case 13, we should keep in mind that EUS-guided through-the-needle biopsy is one of the choices because this method can avoid a hemorrhage into the retroperitoneal cavity after tissue acquisition [ 26 ]. However, a recent study has identified the risk factors and risk classes of an adverse event after EUS-TTNB, and it becomes crucial to select patients before EUS-TTNB to optimize the benefit and risk of this procedure [ 27 ]. Besides, a recent meta-analysis demonstrated that routine use of hemostatic powder is helpful for patients with upper gastrointestinal bleeding, suggestive of the possibility of applying this method to EUS-TA for a subepithelial lesion [ 28 ].…”

Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling

“…29,30 A recent multicenter retrospective analysis of 506 patients who underwent TTN biopsy with microforceps revealed that the incidence of adverse events was 11.5%, and intraductal papillary mucinous neoplasms sampled with multiple microforceps passes were classified as being at high risk for adverse events (28%). 31 Therefore, the risk-benefit balance of TTN biopsy should be carefully considered, and TTN biopsy should be performed in selected patients.…”