Endoscopy 2020; 52(S 01): S170
DOI: 10.1055/s-0040-1704524
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 11:00 – 11:30 Subepithelial tumors ePoster Podium 3
© Georg Thieme Verlag KG Stuttgart · New York

COMPARISON OF ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION (FNA) VERSUS FINE NEEDLE BIOPSY (FNB) AND IMPACT OF RAPID ON-SITE EVALUATION IN THE DIAGNOSIS OF SUBEPITHELIAL LESIONS

DTH de Moura
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, United States of America
,
TR McCarty
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, United States of America
,
P Jirapinyo
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, United States of America
,
IB Ribeiro
2   University of São Paulo Medical School - Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
VK Flumignan
3   Santa Marcelina, Endoscopy Unit, São Paulo, Brazil
,
M Ryou
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, United States of America
,
LS Lee
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, United States of America
,
M Coronel
2   University of São Paulo Medical School - Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
EGH de Moura
2   University of São Paulo Medical School - Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
CC Thompson
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, United States of America
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims While conventional endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remains first-line for sampling subepithelial lesions (SELs), variable accuracy has resulted in increased utilization of fine needle biopsy (FNB) to improve diagnostic yield. The primary aim of this study was to compare FNA versus FNB for diagnosis of SEL.

Methods This was a multi-center, retrospective study to evaluate the outcomes of EUS-FNA and EUS-FNB of SELs over a 3-year period. Demographics, lesion characteristics, sensitivity, specificity, accuracy, number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block accuracy, as well as adverse events were analyzed. Subgroup analyses were performed comparing FNA versus FNB by location as well as diagnostic yield with or without ROSE. Multivariable logistic regression was also performed.

Results A total of 229 patients with SELs (n=115 FNA and n=114 FNB) underwent EUS-guided sampling. Mean age was 60.86±12.84 years. Most lesions were gastric in location (75.55%) and from the fourth layer (71.18%). Cell-block for FNB required fewer passes to achieve conclusive diagnosis (2.94±1.09 versus 3.55±1.55;P=0.003). Number of passes were not different for ROSE adequacy (P=0.167). Immunohistochemistry (IHC) was more common among FNB samples (69.30% versus 40.00%;P< 0.001). Overall, sensitivity and accuracy were superior for FNB versus FNA [(79.41% versus 51.92%;P=0.001) and (88.03% versus 77.19%;P=0.030]. On the subgroup analysis, sensitivity and accuracy of FNB alone was superior to FNA+ROSE [(79.03% versus 46.67%;P=0.001) and (87.25% versus 68.00%;P=0.024]. There were no significant difference in diagnostic yield of FNB alone versus FNB+ROSE (P>0.05). Multivariate analysis showed no predictors associated with accuracy. One minor adverse event was reported in the FNA group.

Conclusions EUS-FNB is superior to EUS-FNA in the diagnosis of SELs. EUS-FNB was superior to EUS-FNA alone and EUS-FNA+ROSE. These results suggest EUS-FNB should be considered a first-line modality and suggest a reduced role for ROSE in the diagnosis of SELs.