87 Comparison of EUS-Guided Fine-Needle Aspiration Alone Versus Combined Fine-Needle Aspiration and Fine-Needle Biopsy in the Diagnostic Evaluation of Solid Pancreatic Lesions

Abstract

INTRODUCTION: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is the standard method to obtain tissue sample for diagnosis of solid pancreatic masses but has variable accuracy. Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) is a new technique that has been shown to have higher diagnostic yield compared to EUS-FNA. In October 2016, one of the authors (MS) began performing a combination of both FNA and FNB for solid pancreatic masses using a single 22 g Shark-core needle for possible higher diagnostic yield. Our study aims were to compare the diagnostic yield of combined EUS-FNA plus FNA versus EUS-FNA alone in solid pancreatic lesions. METHODS: We performed a retrospective chart review on all patients who underwent endoscopic ultrasound (EUS) by a single operator (MS) at Cleveland Clinic between 2015–2018. We included all adult patients who underwent either EUS-FNA or EUS-FNA + FNB for solid pancreatic or peripancreatic masses for the first time. Our primary outcome was to compare the diagnostic yield between the two groups (EUS-FNA versus EUS-FNA + FNB). EUS-FNA was performed using a 22-gauge needle (Boston Scientific) and EUS-FNA + FNB was performed using a 22-gauge Shark-core needle (Medtronic). Diagnostic yield was defined as the proportion of patients in whom a definitive tissue diagnosis was established from EUS sampling. The diagnostic accuracy was defined as the proportion of true positive and true negative EUS sampling results. P < 0.05 was considered significant. RESULTS: A total of 544 patients underwent EUS during the study period, of which 78 patients met the inclusion criteria. Of these 78 patients, 44 patients underwent EUS-FNA and 34 patients underwent EUS-FNA + FNB. EUS-FNA + FNB had a statistically significant higher diagnostic yield compared to EUS-FNA (97.1% vs. 72.7%; P = 0.02). EUS-FNA + FNB also had a higher diagnostic accuracy than EUS-FNA, but this was not statistically significant (P = 0.13). The number of needles passes were lower in the combined FNA + FNB group compared to FNA group (4 vs 5, P = 0.005). There was no significant difference in procedure duration between the two groups. CONCLUSION: Our study showed that combined EUS-FNA + FNB had higher diagnostic yield and required lower number of needle passes compared to EUS-FNA alone for solid pancreatic masses. EUS-FNA + FNB also had higher diagnostic accuracy; although this was not statistically significant. Based on our study findings, we suggest considering the combination of EUS-FNA + FNB for solid pancreatic lesions.