Initial Experience With Endoscopic Ultrasound-Guided Fine Needle Biopsy in a Safety Net Patient Population

Abstract

Introduction: EUS-guided fine needle biopsy (EUS-FNB) has emerged as a novel alternative to EUS-guided fine needle aspiration (EUS-FNA) by providing tissue amendable for histologic evaluation with preserved cell morphology and architecture. Recent technologies have focused on modified bevel design to improve EUS-FNB tissue acquisition. Our goal was to evaluate the performance of EUS-FNB with new generation biopsy needles in a safety net patient population. Methods: Electronic database of endoscopic procedures was retrospectively queried for all procedures performed with EUS-FNB needles (Acquire, Boston Scientific or Shark Core, Medtronic) from 5/2016 to 5/2017. A standard technique was used with an average of 2-5 passes and 10 to-and-fro movements per pass; all procedure were performed by 3 experienced endoscopists. All specimens were collected, fixed in formalin, and were processed as histology. Data extraction was performed for patient demographics, target lesion, diagnostic adequacy, diagnostic accuracy, and complications. Diagnostic accuracy was assessed based on clinical follow-up in thirty-five cases, surgical follow-up in three cases and repeat biopsy in two cases. Results: 40 biopsies were performed with the following target sites: pancreatic lesions (53%), liver parenchyma (15%), abdominal mass (7.5%), submucosal lesions (7.5%), lymph nodes (7%), gastric mass (5%), hilar (2.5%) and ampulla masses (2.5%). Of the pancreatic lesions, 33% displayed a cystic component. Overall diagnostic adequacy of EUS-FNB was 32/40 (80%). Overall diagnostic accuracy was 29/38 (76%), with 2 patients pending follow-up at this time. Diagnostic adequacy and accuracy for pancreatic lesions was 15/21 (71%) and 13/20 (65%), respectively. Of non-cystic pancreatic lesions 12/14 (86%) were diagnostically adequate while 11/14 (79%) were diagnostically accurate. Diagnostic adequacy and accuracy for liver parenchymal, abdominal and submucosal mass biopsy were 12/12 (100%). Diagnostic accuracy for adequate specimens was 31/32 (97%). There were no procedural complications. Conclusion: Our data suggests that EUS-FNB is a safe alternative to EUS-FNA with adequate and accurate core tissue acquisition while used in a complex patient population with a variety of target lesions.