ENDOSCOPIC ULTRASOUND-GUIDED THROUGH-THE-NEEDLE MICROFORCEP BIOPSY IMPROVES THE CATEGORIZATION OF THE TYPE OF PANCREATIC CYSTIC LESIONS

Aims Endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) was introduced and has been performed for the diagnosis of pancreatic cystic lesions (PCLs). However, there is limited data regarding its efficacy and safety. We aimed to evaluate the feasibility, efficacy, and safety of EUS-TTNB in categorizing the types of PCLs, and to analyze factors associated with diagnostic failure.

Methods We retrospectively reviewed the EUS database to identify patients with PCL who underwent EUS-TTNB between January 2019 and November 2021. Technical success, diagnostic yield, and adverse events were analyzed. The discrepancies in the diagnosis between EUS-TTNB and the presumptive diagnosis made by conventional diagnostic modalities (i.e., EUS-morphology, cross-sectional imaging, and cystic fluid analysis) were also evaluated.

Results A total of 79 patients were analyzed. EUS-TTNB was successfully performed in all patients (technical success=100%). Histologic diagnosis of PCL was made in 64 patients (diagnostic yield=82%). Comparing EUS-TTNB with presumptive diagnosis, EUS-TTNB changed the diagnosis in 15 patients in terms of the categorization of the types of PCLs. There was significant difference in diagnostic yield between groups according to number of biopsies per session (≥4 biopsies, 93% vs.<4 biopsies, 67%; P=0.045). Procedure-related adverse events occurred in 6 (8%) patients.

Conclusions EUS-TTNB showed high technical feasibility, diagnostic yield, and acceptable safety profile. EUS-TTNB as an adjunct to other modalities may improve the categorization of the types of PCLs. Studies with standardized procedure protocols and microforceps with improved designs are needed to reduce the diagnostic failure for the types of PCLs.

Publication History

Article published online:
14 April 2022