Endoscopy 2020; 52(S 01): S226-S227
DOI: 10.1055/s-0040-1704708
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 14:30 – 15:00 FNA vs FNB for PANCREATIC CANCER ePoster Podium 3
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASOUND FINE NEEDLE BIOPSY SHOULD BE THE PREFERRED FIRST-LINE DIAGNOSTIC SAMPLING MODALITY FOR PANCREATIC MASS

DTH de Moura
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
TR McCarty
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
P Jirapinyo
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
IB Ribeiro
2   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
KE Hathorn
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
ACM Neto
2   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
M Ryou
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
LS Lee
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
M Coronel
2   University of São Paulo Medical School – Gastrointestinal Endoscopy Unit, São Paulo, Brazil
,
EGH de Moura
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
,
CC Thompson
1   Brigham and Women’s Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Boston, U S A
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is traditionally considered a first-line strategy for diagnosing pancreatic lesions; however, given less than ideal accuracy rates, fine needle biopsy (FNB) has been recently developed to yield histological tissue.

Methods This was a multi-center study to evaluate efficacy and safety of EUS-FNA and EUS-FNB for pancreatic lesions. Baseline characteristics including sensitivity, specificity, and accuracy, were evaluated. Rapid on-site evaluation (ROSE) diagnostic adequacy, cell-block accuracy, and adverse events were analyzed. Subgroup analyses comparing FNA versus FNB route of tissue acquisition and comparison between methods with or without ROSE were performed. Multivariable logistic regression was also performed.

Results A total of 574 patients (n = 194 FNA, n = 380 FNB) were included. Overall sensitivity, specificity, and accuracy of FNB versus FNA were similar [(89.09% versus 85.62%;P = 0.229), (98.04% versus 96.88%;P = 0.387), and 90.29% versus 87.50%;P = 0.307)]. Number of passes for ROSE adequacy and cell-block accuracy were comparable for FNA versus FNB [(3.06 ± 1.62 versus 3.04 ± 1.88;P = 0.11) and (3.08 ± 1.63 versus 3.35 ± 2.02;P = 0.137)]. FNA + ROSE was superior to FNA alone regarding sensitivity and accuracy [91.96% versus 70.83%;P < 0.001) and (91.80% versus 80.28%;P = 0.020)]. Sensitivity of FNB + ROSE and FNB alone were superior to FNA alone [(92.17% versus 70.83%;P < 0.001) and (87.44% versus 70.83%;P << 0.001)]. There was no difference in sensitivity though improved accuracy between FNA + ROSE versus FNB alone [(91.96% versus 87.44%;P = 0.193) and (91.80% versus 80.72%;P = 0.006)]. FNB + ROSE was more accurate than FNA + ROSE (93.13% versus 91.80%;P = 0.001). Multivariate analysis showed ROSE was a significant predictor of accuracy [OR 2.60 (95% CI, 1.41–4.79)]. One adverse event occurred after FNB resulting in patient death.

Conclusions Sensitivity was similar between EUS-FNA + ROSE and EUS-FNB alone suggesting a decreased role for ROSE as a routine procedure. However, FNB + ROSE further increased diagnostic yield and may be useful in cases with previous indeterminate EUS-guided sampling.