Randomized trial of contrast-enhanced harmonic guidance versus fanning technique for EUS-guided fine-needle biopsy sampling of solid pancreatic lesions

Abstract

For EUS-guided fine-needle biopsy (EUS-FNB) of solid pancreatic lesions (SPLs), the role of sampling strategy between a targeted biopsy and wide sampling has not been reported. This study aimed to investigate the benefits of the two sampling techniques on EUS-FNB with rapid on-site evaluation. Patients with SPLs were prospectively enrolled and randomly assigned (1:1) to undergo EUS-FNB using either contrast guidance or the fanning technique. The primary outcome was the total number of passes required to establish a diagnosis, and the secondary outcomes were overall diagnostic accuracy and complication rates. A total of 118 patients were enrolled from February 2019 to January 2021, with 59 patients assigned to each group. There was no significant difference in the total number of passes required to establish a diagnosis between the contrast and fanning groups (median 1 [interquartile range 1-1] vs. 1 [1-2]; P = .629). The sensitivity, specificity, and diagnostic accuracy in the contrast and fanning groups were 100%, 66.7%, and 98.3%, versus 100%, 100%, and 100%, respectively (P = 1). An SPL size < 4 cm (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.05-5.81; P = .037) and macroscopic visible core length > 1 cm (OR, 2.89; 95% CI, 1.07-7.84; P = .037) were independently associated with increased cytologic and histologic accuracy. The diagnostic accuracy of EUS-FNB with the fanning technique for SPLs was comparable with the contrast guidance technique. Without additional cost, EUS-FNB with the fanning technique may be preferred for SPLs.