Comparison of endoscopic ultrasound (EUS)-guided fine needle aspiration with and without rapid onsite evaluation of cytopathology (ROSE) in solid lesions

Aims Endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) are the gold standard techniques for the diagnosis of solid pancreatic and peripancreatic lesions [1]. The reported diagnostic yield of EUS-FNA is approximately 78% [2], and the benefit of rapid on-site evaluation (ROSE) of cytological samples during the procedure remains controversial [3]. The aims of this study are to evaluate possible differences in diagnostic yield, number of passes, needles gauge size or complications of EUS-FNA with and without ROSE.

Methods A unicentric retrospective cohort study was performed. EUS-FNA procedures of solid lesions performed during 6 months with ROSE and 6 months without ROSE were collected. Three EUS-specialized endoscopists performed all EUS-FNA procedures and three gastrointestinal cytopathology specialists conducted the anatomopathological analysis.

Results 120 EUS-FNAs were performed on 103 patients; their baseline characteristics are summarized in Table 1. The most frequent locations were: pancreas (n=65, 63.1%) and peripancreatic lymph nodes (n=11, 10.7%). The mean lesion size was 28.6 mm (SD±15.6). The median number of passes was 2 (IQR 1–3). The most frequently used needles were: 25G in 64 lesions (62.1%), 22G in 20 (19.4%) and 22G SharkCore in 7 (6.8%). Regarding the cytological diagnosis, 60 cases (58.2%) were suggestive of malignancy, 23 (22.3%) negative for malignancy, 3 (2.9%) indeterminate for malignancy and 17 (16.5%) were insufficient for diagnosis. A total of 2 complications (1.9%) were recorded. 45 EUS-FNAs (43.7%) were performed with ROSE and 58 (56.3%) without ROSE. In the EUS-FNA with ROSE cohort, patients were older (79 years±36.9 vs 69±16.9) (p<0.01) and 25G needles were more frequently used (84% vs 48%) (p<0.01). No significant differences were found between ROSE vs without ROSE in terms of median number of passes (3 [IQR 2–3] vs 2 [IQR 2–3]; p=0.10) or complications (1 [2.0%] vs 1 [1.4%]; p=0.9). In the ROSE cohort, 6 EUS-FNAs (12.2%) had to be repeated due to insufficient diagnostic samples, compared to 14 (19.7%) in the non-ROSE cohort (p=0.3). With ROSE, EUS-FNA provided a definitive diagnosis in 38 cases (77.6%), vs 53 cases (74.6%) without ROSE (p=0.9). Analysis of the subgroup with definitive diagnoses showed higher use of 25G needles with ROSE (82% vs 45% without ROSE; p<0.001) and 22G needles without ROSE (36% vs 5% with ROSE; p<0.001).

Conclusions In our experience, no significant differences were found in the diagnostic yield of EUS-FNA with and without ROSE, nor in the number of passes or the rate of complications. Smaller gauge needles were more frequently used in the ROSE cohort compared to the non-ROSE cohort.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Kong F, Zhu J, Kong X, Sun T, Deng X, Du Y. et al. Rapid on-site evaluation does not improve endoscopic ultrasound-guided fine needle aspiration adequacy in pancreatic masses: a meta-analysis and systematic review. PLoS One 2016; 11 (9): e0163056
• 2 Cherian PT. et al. “Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic and peripancreatic lesions: is onsite cytopathology necessary?.”. HPB : the official journal of the International Hepato Pancreato Biliary Association 2010; 12 (6): 389-95
• 3 Chen YI. et al. “Endoscopic ultrasound (EUS)-guided fine needle biopsy alone vs. EUS-guided fine needle aspiration with rapid onsite evaluation in pancreatic lesions: a multicenter randomized trial.”. Endoscopy 2022; 54 (1): 4-12