Abstract
This is a prospective and comparative study including 76 consecutive patients performing EUS-FNB for pancreatic and extrapancreatic solid lesions, randomized by alternate allocation to macroscopic on-site evaluation (MOSE) (40 patients) or to a conventional technique (40 patients), with three passes each. MOSE samples were differentiated into score 0: no visible material, score 1: only necrotic or haematic material, score 2: white core tissue ≤ 2 mm, or score 3: white core tissue > 2 mm. The conventional technique consisted in pushing all the needle content into a test tube for evaluation by the pathologist. In both groups, a 22–25 Gauge Franseen-tip needle (Acquire, Boston Scientific Co., Natick, MA, USA) was used. The study evaluated the diagnostic accuracy and adequacy of MOSE compared to the conventional technique and whether MOSE could optimize the number of passes during EUS-FNB. Results: The analysis was performed on 76 patients (38 MOSE, 38 conventional). The overall diagnostic adequacy was 94.7% (72/76) and accuracy was 84.2% (64/76). The diagnostic accuracy was similar in the two groups: MOSE 86.8% (33/38 lesions), vs. conventional 81.6%, 31/38 lesions, p = 0.76). Regarding diagnostic adequacy, the MOSE technique was 97.4% (111/114 passes) compared to 92.1% (105/114 passes) with the conventional technique, p = 0.06. The accuracy increased according to the MOSE score evaluation: it was 43.5%, 65.5% and 78.3% in patients with score 1, score 2, and score 3, respectively. Moreover, if in the first two passes the MOSE score was 2 or 3, the accuracy was 82.6% (20/23), and upon adding a third pass, the accuracy increased to 87% (20/23), which was not significantly different from the general accuracy of the MOSE samples (86.8%) (p = 0.86). Conclusions: The MOSE score showed a comparable diagnostic accuracy to the conventional technique. However, MOSE allows endoscopists to perform an inspective evaluation of the material, tends to perform better than the conventional technique in terms of diagnostic adequacy, and may potentially reduce the number of passes.
Highlights
The endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is potentially capable of providing sufficiently large and well-preserved core specimens to allow for the assessment of the architecture of the surrounding tissue and stroma, and it has been proposed as an alternative to overcome the limits of FNA [1,2,3,4,5]
The aim of the present study was to evaluate the accuracy of the Macroscopic on-site evaluation (MOSE) technique and its diagnostic adequacy compared to the conventional technique during the FNB of pancreatic and extrapancreatic lesions
In the MOSE arm, two patients were excluded from the final cytohistological analysis as it was not possible to follow the established protocol—in one case for premature interruption of the examination due to anaesthesiologic problems, and in the other for failed penetration of the gastric wall
Summary
The endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is potentially capable of providing sufficiently large and well-preserved core specimens to allow for the assessment of the architecture of the surrounding tissue and stroma, and it has been proposed as an alternative to overcome the limits of FNA [1,2,3,4,5]. Macroscopic on-site evaluation (MOSE) consists in the direct macroscopic evaluation of the core tissue obtained from EUS-FNB by the operator, in order to estimate the adequacy of the sample to be provided for subsequent cyto-histological evaluation [6]. The advantage of this approach lies in the fact that the endosonographer can have an immediate idea, “on-site”, of the material taken in terms of quantity and quality—data that may potentially be useful when deciding the number of passes. This could be especially useful in patients with a higher procedural risk, or for whom a shorter examination duration and/or less invasiveness can constitute an element of safety. The study evaluated whether the MOSE technique could reduce the number of passes by providing a macroscopic evaluation of the sample
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