Comparison between accuracy of flexible nitinol fine needle aspiration(FNA) and fine needle biopsy(FNB) endoscopic ultrasound (EUS) needles for solid pancreatic masses-retrospective bicentric analysis

AIM To investigate the accuracy of flexible nitinol FNA and EUS-FNB needle for pancreatic masses in 2 Austrian centers(Klagenfurt and St.Pölten).

METHODS Our bicentric study included EUS biopsies of pancreatic masses performed between 02/2017-10/2019-Klagenfurt and between 11/2018-10/2019-St.Pölten. Olympus (19 or 22 G)flexible nitinol needle were used for EUS-FNA and SharkCore^TM(19 or 22G) or Boston Acquire^TM(22G) were used for EUS-FNB. Needles were chosen according to the availability in the centers or endoscopist preference. 124patients with 134EUS-FNA/FNB(Klagenfurt -90,St. Pölten-44) of solid pancreatic masses were enrolled in this retrospective study.Final diagnosis was established through a combination of histopathology, surgery, radiological findings, autopsy and clinical follow-up. The accuracy was calculated as the proportion of true positive+true negative cases/total number of cases, while Se for malignancy represented the rate of true positive samples/all malignant cases. Positive EUS-FNA/FNB was defined as the finding of at least atypical cells with dysplasia. An“experienced”endosonographer had performed at least 225 EUS including 50 interventions(at least 25 performed for pancreatic tumors).

RESULTS The most common final diagnosis was adenocarcinoma(61,2 %), following by and pseudotumor due to chronic pancreatitis(11.2 %) and inflammation(10.4 %).Overall, 70.9 % of cases presented with malignancy. The EUS-FNA needle were used in 64/83(56.7 %) cases.Trainees performed 51.4 %of all EUS. The overall accuracy and Se for detecting malignancy were:77.6 % and 66.1 %,respectively. The accuracy and Se for malignancy for EUS-FNB was significantly higher as compared with EUS-FNA needles: 86.2 % vs.71 %, p = 0.04 and 85 % vs.64.2 %, p = 0.04. The use of EUS-FNB needles by experienced endosonographers was associated with 90 % Se for malignancy(Table).

CONCLUSION The use of EUS-FNB needles in centers without on-site pathologist is associated with increased accuracy for EUS-guided biopsy of solid pancreatic masses, especially when there are used by experienced endosonographers.

Tab. 1

	Accuracy	Se for malignancy
Experienced endosonographers	-FNA:14/19(73.6 %) -FNB:41/46(89.1 %) p = 0.23	-FNA:9/14(64.2 %) -FNB:27/30(90 %) p = 0.09
Trainees	-FNA:40/57(70.1 %) -FNB:9/12(75 %) p = 0.99	-FNA:27/42(64.2 %) -FNB:7/10(70 %) p = 0.78

Publication History

Article published online:
26 May 2020