Diagnostic performance of endoscopic ultrasound-guided tissue acquisition by EUS-FNB for solid pancreatic lesion: a Tunisian retrospective study

Aims Endoscopic ultrasound (EUS) has been established as the reference for the histologic diagnosis of solid pancreatic lesions, as it is efficient and safe. It has been performed for several years in our country, but there are currently few data evaluating its performance. The aim of our study was to evaluate the performance of fine needle biopsy (FNB) in adults undergoing EUS –guided sampling of solid pancreatic lesions.

Methods We conducted a retrospective study from 2018 to 2023 including all patients who were subjected to EUS- FNB sampling for solid pancreatic lesions suspicious of malignancy. Patients with pancreatic cysts and known chronic pancreatitis were excluded. The diagnosis of malignancy was defined by the presence of cancer cells on biopsy or on surgical specimen or by a follow-up featuring a tumour progression or the onset of metastases. Technical failure was defined as the presence of insufficient and/or normal pancreatic tissue material assessed by the pathologist.

Results A total of 224 patients were included in the final analysis: 136 men and 88 women with a sex ratio M/F of 1.54. The mean age was 62 years. The mean size of the mass was 34.79 mm, mainly located in the head (70.5%), body (12.5%), uncinate process (9.4%), neck (5.8%) and tail (1.3%). Vascular invasion was found in 16.1% while close vascular contact was retrieved in 54% of cases. The approach was mostly transduodenal (90.6%) and transgastric (9.4%). A 22 gauge needle was used in 99.1% of cases. Technical success was noted in 96% of cases and was significantly correlated to the tumor size p=0.01. The diagnosis of histological malignancy was made in 94.6% of cases. Immunohistochemistry staining was performed in 14.3% of patients. Pancreatic adenocarcinoma was the most common tumor histologic type (93.34%) with ductal (97.9%) and acinar cell (2.1%) as most frequent subtypes. A signet ring cell and mucinous components were found in 19.1 and 5% of cases respectively. The remaining cases listed six pancreatic neuroendocrine tumors, two mucinous cystadenocarcinoma and six pancreatic metastases from another primary site: 3 metastases of clear cell renal carcinoma, one metastasis of colon adenocarcinoma, one metastasis of breast carcinoma, and one metastasis of small cell lung cancer. Benign lesions were recognised in 2 cases depicting mass-forming chronic pancreatitis. EUS guided -FNB showed a high performance for malignant diagnosis adequacy (Se: 95.08%, VPP: 100%, accuracy: 95.08%). Second biopsy set was performed in only 2 patients, with a cumulated sensitivity and accuracy of 97.5%. Only one case of major bleeding was reported.

Conclusions EUS with FNB biopsy is a safe procedure featuring high rates of technical success and accuracy for the diagnosis of pancreatic solid mass. Nevertheless, its use remains limited in developing countries due to its high cost and the limited availability.

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Artikel online veröffentlicht:
15. April 2024