S0913 Technical and Histopathologic Success of 22-Gauge Needle for EUS-Guided Tissue Acquisition (EUS-FNB) in Pancreaticobiliary Neoplasms: A Large Retrospective Single Center Study

Abstract

INTRODUCTION: Endoscopic ultrasound (EUS)-guided core biopsy (EUS-FNB) can obtain sample for histopathologic examination with architectural preservation and provide sample for rapid on-site evaluation (ROSE). EUS-guided fine needle aspiration (EUS-FNA) for pancreatic neoplasms has a sensitivity of about 85%. EUS-FNB using 22-gauge (G) needle has shown early promise for diagnosis of pancreatic and peripancreatic lesions. Our aim is to study the technical success of 22-G needle in histopathologic diagnosis of pancreaticobiliary (PB) neoplasms. METHODS: This is a retrospective study of patients who underwent EUS-FNB utilizing 22-G needle (SharkCore™) and had a diagnosis of pancreatic or biliary neoplasm. RESULTS: Total number of patients included was 337. Mean age of the patients was 67.4 years and 48.66% (164 of 337) were female. Mean duration of the procedure was 43.34 minutes and 38.73 minutes excluding cases with ERCP. Median number of passes was 3. ROSE was available for 92.28% (311 of 337) with 90.6% (282 of 311) correlating with histopathologic diagnosis. In 14 cases (4.15%) use of 19-G needle was required for adequate sampling and repeat biopsy was required for diagnosis in 4 cases (1.18%). Malignant lesions were found in 298 of the 337 samples (88.42%) with 289 (85.75%) being primary PB cancers. The most common histopathologic diagnosis was pancreatic ductal adenocarcinoma (PDAC) found in 246 (72.99%), followed by benign cyst in 23 (6.82%), biliary cancers in 22 (6.52%), neuroendocrine tumor in 21 (6.23%), six IPMN, and one each had duodenal and ampullary cancers. Eight patients had acute pancreatitis (AP) and one had severe abdominal pain requiring hospitalization. Five of the eight patients who developed AP had simultaneous endoscopic retrograde cholangiopancreatography. All the 9 patients had malignant disease. Six of the 8 AP events occurred in patients with PDAC and 5 of the 6 had biopsy performed in head or uncinate process. All the episodes of AP were mild without intensive care unit admission or death. CONCLUSION: Our study demonstrates greater than 90% sensitivity of EUS-FNB using 22 G needle in the diagnosis of PB neoplasms which exceeds that of EUS-FNA (sensitivity ∼85%). In conjunction with ROSE it provides more accurate real-time diagnosis. Also, the core obtained allows adequate sample for precision medicine and immunohistochemical analysis. Thus, EUS-FNB is a safe and effective modality for the accurate diagnosis of PB neoplasms.