Efficacy of EUS-guided FNB using a Franseen needle for tissue acquisition and microsatellite instability evaluation in unresectable pancreatic lesions

Mitsuru Sugimoto,Tadayuki Takagi,Yuki Sato,Naoki Konno,Hiromasa Ohira,Minami Hashimoto,Yuko Hashimoto,Hiroki Irie,Ryoichiro Kobashi,Yasuyuki Kobayashi,Jun Nakamura,Hiroyuki Asama,Tsunetaka Kato,Rei Suzuki,Mika Takasumi,Takuto Hikichi

doi:10.1186/s12885-020-07588-5

Abstract

BackgroundThe efficacy of immune checkpoint blockade in the treatment of microsatellite instability (MSI)-high tumors was recently reported. Therefore, the acquisition of histological specimens is desired in cases of unresectable solid pancreatic lesions (UR SPLs). This study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for UR SPL tissue acquisition and MSI evaluation.MethodsA total of 195 SPL patients who underwent EUS-guided fine-needle aspiration (EUS-FNA) or EUS-FNB (EUS-FNAB) between January 2017 and March 2020 were enrolled in this study. Among them, 89 SPL patients (FNB: 28, FNA: 61) underwent EUS-FNAB using a 22-G needle (UR SPLs: 58, FNB: 22, FNA: 36) (UR SPLs after starting MSI evaluation: 23, FNB: 9, FNA: 14).ResultsThe puncture number was significantly lower with FNB than with FNA (median (range): 3 (2–5) vs 4 (1–8), P < 0.01, UR SPLs: 3 (2–5) vs 4 (1–8), P = 0.036). Histological specimen acquisition was more commonly achieved with FNB than with FNA (92.9% (26/28) vs 68.9% (42/61), P = 0.015, UR SPLs: 100% (22/22) vs 72.2% (26/36), P < 0.01). The histological specimen required for MSI evaluation was acquired more often with FNB than with FNA (88.9% (8/9) vs 35.7% (5/14), P = 0.03).ConclusionsEUS-FNB using a Franseen needle is efficient for histological specimen acquisition and sampling the required amount of specimen for MSI evaluation in UR SPL patients.

Highlights

The efficacy of immune checkpoint blockade in the treatment of microsatellite instability (MSI)-high tumors was recently reported
Patients A total of 195 Solid pancreatic lesion (SPL) patients who underwent EUS-guided fine-needle aspiration (EUS-FNA) or endoscopic ultrasoundguided fine-needle biopsy (EUS-FNAB using a 22-G needle (FNB)) (EUS-FNAB) between January 2017 and March 2020 were enrolled in this study (Fig. 1)
The puncture number was significantly lower with FNB than with FNA (median; 3 (2–5) vs 4 (1– 8), P value < 0.01)

Summary

Introduction

The efficacy of immune checkpoint blockade in the treatment of microsatellite instability (MSI)-high tumors was recently reported. This study investigated the efficacy of endoscopic ultrasoundguided fine-needle biopsy (EUS-FNB) using a Franseen needle for UR SPL tissue acquisition and MSI evaluation. Endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) is a safe and efficient procedure for diagnosing solid pancreatic lesions (SPLs), with a reported diagnostic sensitivity, specificity, and accuracy for SPL of 79–95.0%, 75.0– 100%, and 78.0–96.0%, respectively [1,2,3,4,5,6]. EUS-guided fine-needle biopsy (EUS-FNB) using a TruCut. Microsatellite instability (MSI) is known as a predictive biomarker for the therapeutic effect of immune checkpoint blockade. Pembrolizumab has been proposed as a second-line treatment for any MSI-high cancer patients [10, 11].

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