Importance of rapid on-site evaluation during endoscopic ultrasound-guided fine-needle biopsy in solid pancreatic lesions

Aims Solid pancreatic lesions present significant diagnostic challenges, often requiring advanced techniques for accurate tissue acquisition. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has emerged as a key diagnostic tool due to its high safety profile and reliability. The use of rapid on-site evaluation (ROSE) during EUS-FNB further enhances its diagnostic yield by providing real-time assessment of sample adequacy and enabling immediate clinical decision-making. However, despite its advantages, the European Society of Gastrointestinal Endoscopy emphasizes the need for additional evidence to fully establish its utility.

Methods We conducted a retrospective review of data from 80 EUS-FNB procedures performed for solid pancreatic lesions at Semmelweis University's Institute of Pancreatic Diseases since November 2023. Of these, 40 cases utilized rapid on-site evaluation (ROSE) during the procedure, while the remaining 40 cases were performed without ROSE. Patient demographics, lesion characteristics, histological findings, and procedural outcomes were documented for all cases. Descriptive statistics were employed to analyze and summarize the data, focusing on diagnostic yield, sample adequacy, and procedural success rates. Comparative analyses were performed to assess potential differences between procedures with and without ROSE.

Results All procedures were performed using 22G FNB needles. In the ROSE group, the mean number of needle passes was three, while in the non-ROSE group, it was four. Lesion diameters were larger in the ROSE group, with a mean size of 31.8×27.3 mm compared to 25×20 mm in the non-ROSE group. In the ROSE group, most lesions (73%) were hypoechogenic, and 27% displayed heterogeneous echogenicity. In contrast, in the non-ROSE group, hypoechogenic lesions accounted for 74%, 6% had heterogeneous echogenicity, and 20% were cystic. Histological analysis in the ROSE group revealed adenocarcinoma in 50% of cases, normal histology in 20%, other malignancies in 10%, pseudocysts in 10%, and chronic pancreatitis in 15%. Insufficient cellular material was identified in 5% of samples. Lesion locations in this group were predominantly in the pancreatic head (70%), followed by the caudal region (7.5%), body (2.5%), and multiple pancreatic regions (20%). Repeated tissue acquisition was necessary in 12.5% of cases, which resulted in two additional adenocarcinoma diagnoses. In the non-ROSE group, histological findings included adenocarcinoma in 37.5%, normal histology in 20%, other malignancies in 22.5%, pseudocysts or chronic pancreatitis in 15%, and insufficient cellular material in 5%.

Conclusions EUS-FNB has a crucial role in the diagnosis of solid pancreatic lesions and provides valuable guidance for clinicians in selecting therapy. When paired with ROSE, it may reduce the number of needle passes required during the procedure.

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Artikel online veröffentlicht:
27. März 2025