Eyes wide open: MOSE Performance in EUS FNB

Aims Endoscopic ultrasound fine needle biopsy (EUS-FNB) is the preferred method for sampling solid lesions in the digestive wall or adjacent organs. Strategies to enhance its efficacy have been explored, with recent studies indicating that Macroscopic On-Site Evaluation (MOSE) by an echoendoscopist can be comparable to Rapid On-site Evaluation (ROSE) by an anatomopathologist. This study aims to assess the performance of MOSE in EUS-FNB, specifically using the 22G Franseen needle.

Methods Single-center retrospective cohort study, including all consecutive patients who underwent EUS-FNB with a 22G Franseen needle to characterize solid lesions, with a standardized description of MOSE, between April 2021 and September 2023. The performance of MOSE was evaluated, with diagnostic yield being considered when obtaining of diagnostic cytology, and diagnostic accuracy as the quotient between correctly diagnosed cases and the total number of cases. The final diagnosis was made based on the pathology of the surgical specimen or clinical/imaging evolution. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated considering malignant and benign lesions as positive and negative results, respectively.

Results 57 patients were included, with 53% men, and 60 punctures were performed (57% pancreatic, 25% subepithelial, 3% hepatic/biliary, 3% lymph node, 3% adrenal, 8% perirectal). Median lesion size was 30 mm (inter-quartile range (IQR) 20-40 mm), with a median of 3 (IQR 2-4) passes. Echoendoscopist detected filamentary material in 100% of the exams. White fragments were obtained in 91% of exams, with a maximum median dimension of 5 mm (IQR 3-10 mm). There was a diagnostic yield in 92% of the exams, with a diagnostic accuracy of 90%. Sensitivity, specificity, PPV and NPV were, respectively, 97%, 100%, 100% and 94%. Self-limited hemorrhage was found in 1 of the exams. Fragments≥4 mm were associated with a higher diagnostic yield (p=0.01), unlike the color of the fragment.

Conclusions This study suggests that MOSE utilization during EUS-FNB is associated with a substantial diagnostic yield. Fragments≥4 mm are associated with a high likelihood of obtaining a diagnostic cytology, and ensuring high diagnostic accuracy, sensitivity, specificity, PPV and NPV.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024