Sampling Of Solid Pancreatic Lesions Research Articles

Rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) for endoscopic ultrasound-guided sampling of solid pancreatic lesions: a paired comparative analysis using newer-generation fine needle biopsy needles.

Rapid on-site examination (ROSE) during endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been a subject of debate. We compared the yield of EUS-FNB with adequacy assessed using macroscopic on-site evaluation (MOSE), and smear cytology with adequacy confirmed by ROSE, acquired using the same needle. Consecutive patients with solid pancreatic lesions (SPLs) who underwent EUS-FNB of pancreatic solid lesions between January 2021 and July 2022 were included. Demographic details, site and size of lesion, number of passes, and the diagnosis by cytology and histopathology of core tissue were noted. The first pass was used for ROSE adequacy assessment and was subsequently sent for cytological assessment. Additional passes were taken subsequently to acquire core tissue. Adequacy was confirmed by MOSE (whitish core of more than 4 mm). Final cytology and histopathology (HPE) were compared for diagnostic accuracy. One hundred fifty-five patients were included in the analysis during the study period (mean age 55.1+12.9 years; 60% male; 77% in pancreatic head; median size 3.7 cm). The final diagnosis was malignancy in 129, while 26 were negative for malignancy. Sensitivity and specificity for ROSE with cytology in detecting malignant SPLs were 96.9% and 100%, respectively. HPE with MOSE had sensitivity and specificity of 96.1% and 100%, respectively. A comparison of diagnostic accuracy showed no significant difference (P>0.99) between HPE with MOSE and ROSE with cytology, using an FNB needle. MOSE is as good as ROSE in terms of diagnostic yield for solid pancreatic lesions sampled using newer-generation EUS biopsy needles.

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

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.

Factors Affecting the Learning Curve in the Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Prospective Study.

Endosonography is associated with a long learning curve. We aimed to assess variables that may influence the diagnostic outcomes in endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) of solid pancreatic tumors regarding the level of endoscopists' experience. Consecutive patients undergoing EUS-guided puncture of solid pancreatic tumors (eight endosonographers, including six trainees) were prospectively enrolled. An experienced endosonographer was defined as having performed at least 250 EUS examinations, including 75 FNA/Bs. The final diagnosis was determined by cytopathology, histopathology, or clinical follow-up. In total, 283 EUS-FNA/Bs of solid pancreatic tumors (75.6% malignant) in 239 patients (median age 69 years, 57.6% males) were enrolled. Trainees performed 149/283 (52.7%) of the interventions. Accuracy and sensitivity for detecting malignancy were significantly higher in the expert group than in the trainee group (85.8% vs 73.2%, p=0.01 and 82.5% vs 68.4%, p=0.02). Solid lesions evaluated by an expert using FNB needles showed the best odds for a correct diagnosis (odds ratio, 3.07; 95% confidence interval, 1.15 to 8.23; p=0.02). More experienced endoscopists achieved better accuracy in sampling via the transduodenal approach (86.7% vs 68.5%, p<0.001), in the sampling of malignant lesions (82.5 vs 68.4, p=0.02), and in the sampling of lesions located in the pancreatic head (86.1 vs 69.1, p=0.02). In cases involving these factors, we observed a moderate improvement in the diagnostic accuracy after 40 attempts. Transduodenal approach, pancreatic head lesions, and malignancy were recognized as the most important clinical factors affecting the learning curve in EUS-FNA/B of solid pancreatic lesions.

Comparison between EUS-guided fine-needle biopsy with or without rapid on-site evaluation for tissue sampling of solid pancreatic lesions: A systematic review and meta-analysis.

The benefit of rapid on-site evaluation (ROSE) on the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) in patients with pancreatic masses is still matter of debate. Aim of our meta-analysis is to compare the diagnostic outcomes of these two tissue acquisition strategies. Computerized bibliographic search on the main databases was performed through December 2021 and 8 studies were identified (2147 patients). The primary outcome was sample adequacy. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test and summary estimates were expressed in terms of odds ratio (OR) or mean difference and 95% confidence Interval (CI). There was no difference in terms of baseline variables between the two groups. Pooled sample adequacy was 95.5% (95% CI 93.2%-97.8%) and 88.9% (83.4%-94.5%) in the EUS-FNB + ROSE and EUS-FNB groups, respectively (OR = 2.05, 0.94-4.49; P = 0.07). Diagnostic accuracy resulted significantly superior in the EUS-FNB + ROSE group (OR = 2.49, 1.08-5.73; P = 0.03), particularly when the analysis was restricted to reverse bevel needle (OR = 3.24, 1.19-8.82, P = 0.02), whereas no statistical difference was observed when newer end-cutting needles were used (OR = 0.71, 0.29-3.61, P = 0.56). Diagnostic sensitivity was not significantly different between the two groups (OR = 1.94, 0.84-4.49; P = 0.12), whereas pooled specificity was 100% with both approaches. The number of needle passes needed to obtain diagnostic samples was not significantly different (mean difference 0.07,-0.22 to 0.37; P = 0.62). Our meta-analysis stands for a non-superiority of EUS-FNB + ROSE over EUS-FNB with newer end-cutting needles, whereas ROSE could have still a role when reverse bevel needles are used.

Telecytology versus in-room cytopathologist for EUS-guided FNA or fine-needle biopsy sampling of solid pancreatic lesions

Rapid on-site-evaluation (ROSE) with an in-room cytopathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing EUS-guided FNA or fine-needle biopsy sampling (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and use of ROSE using telecytology (ROSE-T) to optimize clinical workflows and to address social distancing mandates created during the coronavirus disease 2019 pandemic. The purpose of this study was to compare diagnostic outcomes of ROSE-P and ROSE-T. A single-center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNAB were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis. There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, P= .428). ROSE-T was associated with an increased use of 22-gauge needles (P= .006) and more needle passes (P< .001). No significant differences were found in age, gender, lesion size, needle type, procedure times, or adverse events between the 2 groups (P< .05 for all). More pancreatic tail lesions were sampled in the ROSE-P group (P< .001). ROSE-T was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.

Two Needle Passes Achieve Similar Diagnostic Yield Compared to Three Passes Regarding Diagnosis of Solid Pancreatic Lesions in Endoscopic Ultrasound-Guided Fine Needle Aspiration.

Current guidelines advocate 3–4 passes with a fine-needle aspiration (FNA) to achieve high rates of diagnostic samples for malignancy when performing endoscopic ultrasound (EUS)-guided sampling of solid pancreatic lesions, in the absence of on-site cytologic evaluation. The aim of this study is to compare 2 vs. 3 needle passes in EUS-FNA for solid pancreatic lesions in terms of incremental diagnostic yield and to identify factors associated with the procedure’s outcome. In this retrospective study, 2 passes of EUS-FNA were found to have similar diagnostic yield compared to 3 passes for the diagnosis of solid pancreatic masses, suggesting that there might be no significant incremental tissue yield when 3 passes are performed.

Use of suction during endoscopic ultrasound-guided fine needle biopsy of solid pancreatic lesions with a Franseen-tip needle: a pilot comparative trial.

Background and study aims The utility of suction during endoscopic ultrasound (EUS) fine-needle biopsy (FNB) using Franseen-tip needle remains unclear and has not been evaluated in randomized trials. We designed a randomized crossover trial to compare the diagnostic yield during EUS-FNB using a 22G Franseen-tip needle, with and without standard suction. Patients and methods Consecutive patients undergoing EUS-guided sampling of solid pancreatic lesions were recruited. A minimum of two passes were performed for each case: one with 20-mL syringe suction (S+) and another without (S–). The order of passes was randomized and the pathologist blinded. The endpoints were the diagnostic yield and the impact of blood contamination in the diagnosis. Results Fifty consecutive patients were enrolled. The overall diagnostic accuracy was 84 %. A diagnosis of malignancy was obtained in 70 samples: 36 in the S+group and 34 in the S–group. A statistically significant difference was seen in the diagnostic accuracy (S+: 78 % vs. S–: 72 %, P < 0.01) and blood contamination (S+: 68 %; S–: 44 %, P < 0.01). The sensitivity, specificity, negative likelihood ratio and positive likelihood ratio for S+vs. S–samples were 76.6 % vs. 73.9 %, 100 % vs. 100 % and 0.23 vs. 0.26, NA vs NA, respectively. A negative impact of blood contamination in the overall diagnostic yield wasn’t seen, even in samples where suction was used (OR 0.36, P = 0.15) Conclusions We found a higher diagnostic yield with the use of suction. It was associated with a higher degree of sample blood contamination that did not affect the diagnostic performance.

Endoscopic Ultrasound-guided Sampling of Solid Pancreatic Lesions: A Comparative Analysis of 25 Gauge Versus 22 Gauge Core Biopsy Needles.

Pancreatic mass sampling has historically been performed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, its sensitivity has been reported to be within a wide range, which limits its reliability. Fine needle biopsy (FNB) has been shown to have superior diagnostic performance and is increasingly replacing fine needle aspiration. In FNA, 25 gauge (G) needles appear to outperform 22G. Data comparing these sizes in FNB platforms is limited. We aimed to prospectively compare the performance of 22G and 25G Franseen-tip core biopsy needles in the sampling of solid pancreatic lesions. Patients who underwent EUS-FNB of pancreatic lesions at the Indiana University Hospital using 2 needle sizes: 25G (Study group) and 22G (Control group) using the Acquire needle (Boston Scientific Co., Natick, MA, USA) were enrolled. Needle choice was left to the discretion of the endosonographer. Tissue specimens were evaluated onsite, and underwent touch and smear and cellblock preparation. Specimens were independently evaluated by 2 expert cytopathologists blinded to diagnosis. Cytopathologists assessed cytological yield (on smears) and histological yield (on cellblock) using a validated scoring system reached by a consensus among our cytopathologists as we have previously published. A total of 75 patients (42 males, median=65 years) underwent EUS-FNB during the study period (2017-2018): 50 using 25G and 25 using 22G needle. Diagnostic yield was numerically higher in 25G (98% vs. 88%, p=0.105). Number of passes for smears were similar, however the 25G group required additional passes for cell-block (1.6 vs. 0.4, p=0.001). 25G was used more frequently for pancreatic head and uncinate process sampling (70% vs. 52%, p=0.126). Four patients had self-limited adverse events in the 22G group, but none in the 25G group. We report no difference in the diagnostic yield between 25G FNB vs. 22G sampling device with Franseen style tip, however, the 25G needle use was associated with the need of additional passes to collect a sufficient cell block.

Dedicated Cytopathologists vs Community Pathologist Significantly Affects Overall Diagnostic Accuracy of Endoscopic Ultrasound Guided Sampling of Solid Pancreatic Lesions: Outcomes From a Large Healthcare System

Endoscopic ultrasound (EUS) is the most sensitive modality in detecting solid lesions of pancreas and is commonly performed for staging, and tissue acquisition. Correct pathologic diagnosis is crucial for timely diagnosis and initiation of therapy in cases of pancreatic adenocarcinoma and could preclude surgery for conditions (i.e. autoimmune pancreatitis) that mimic pancreatic cancer. Aim of our study was to evaluate overall impact of dedicated cytopathologists (DC) versus community pathologists (CP) on overall diagnostic accuracy of EUS guided tissue sampling. EUS fine needle aspiration (FNA) or biopsy (FNB) is currently performed in 6 out of 14 hospitals in our health care system. In only one of the academic tertiary care hospital, EUS FNA is being interpreted by 4 dedicated cytopathologist. In the remaining 5 hospitals, EUS FNA is being interpreted by community pathologists. Total 19 endosonographers performed over 3000 EUS between 2015 to 2019. From this prospective maintained database, we retrospectively reviewed EUS FNA cases for pancreatic solid lesions (PSLs) and collected data regarding patient demographics, PSL size, needle gauge, needle type, adequacy of the obtained sample, the percentage of diagnostic samples and diagnostic accuracy. A total of 575 procedures were performed across the entire hospital system. Mean age of the study population was 65+14. Total of 259 EUS FNA cases were reviewed by CP compared to 316 by DC. EUS FNA samples were more frequently reported as inadequate by CP 63/259 (24.3%), compared to DC 46/316 (14.6%) (p < 0.01). Similarly, overall diagnostic accuracy of EUS FNA was much lower when evaluated by CP 182/259 (70.3%), compared to DC 256/316 (81%) (p < 0.01). In one of the community hospitals, 16 EUS FNA were performed by academic endosonographers and interpretation was done by CP. For the same academic endosonographers, diagnostic yield with CP was 11/16 (68.7%) compared to 270/316 (85.5%) with DC. Our study concludes that EUS-FNA/FNB procedures when performed with dedicated cytopathologist not only improves the diagnostic accuracy but also reduces the chances of inadequate sampling or non-diagnostic results. This approach thereby avoids the necessity of repeating the invasive procedure as well as the delay in accurate diagnosis. Based on this results, further quality improvement initiative will be undertaken to improve overall diagnostic accuracy of EUS-FNA/FNB across the entire hospital system.Tabled 1Table 1DiagnosticCPDCTotalp-valueNo77 (29.7%)60 (14.6%)137 (16.9%)<0.01Yes182 (70.3%)256 (81%)438 (76.2%)Total259316575AdequateCPDCTotalp-valueNo63 (24.3%)46 (14.6%)109 (18.9%)<0.01Yes196 (75.7%)270 (85.4%)466 (81,1%)Total259316575 Open table in a new tab

Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials.

Background and study aims Current ESGE guidelines suggest employing the suction (SU) technique for endoscopic ultrasound (EUS)-guided sampling of pancreatic solid lesions. Nonetheless, recent randomized controlled trials (RCT) have reported that the slow-pull (SP) technique has similar diagnostic accuracy with possibly less blood contamination. However, these results are heterogeneous and limited to small cohorts. The aim of this meta-analysis was to compare adequacy, accuracy, sensitivity and specificity of the SU and SP techniques for EUS-guided sampling of solid pancreatic lesions. Methods A computerized bibliographic search was restricted to RCTs. Pooled effects were calculated using a random-effects model and expressed in terms of pooled sensitivity and specificity and OR (95 % CI) for adequacy and accuracy. Results Overall, seven RCTs were included, for a total of 475 patients (163 lesions sampled with SU, 164 with SP and 148 by both). The adequacy was similar (OR = 0.98) without heterogeneity (I 2 = 0 %), but a high degree of blood contamination was more common with SU than SP (pooled rate 27.6 % vs 19.7 %). A non-significant superiority of SP in terms of pooled accuracy (OR = 0.82; 95 % CI 0.36–1.85) was recorded, with moderate heterogeneity (I 2 = 52.4 %). The SP technique showed a slightly higher pooled sensitivity compared to SU (88.7 % vs 83.4 %), while specificity was similar (97.2 % SP vs 96.9 % SU), with considerable heterogeneity. Conclusion The current meta-analysis reveals non-superiority of SU over SP, while SP results in reduced blood contamination. If the 5 % accuracy difference favouring SP is true, with alfa error = 0.05 and beta = 0.20, a RCT of 982 patients per arm is needed to confirm significance.

893 Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Comparative Analysis of 25 vs. 22 Gauge Core Biopsy Needles

INTRODUCTION: Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) is increasingly replacing fine needle aspiration (FNA) for sampling of solid pancreatic lesions. In FNA, 25G needles appear to outperform 22G needles in sampling pancreatic lesions, but data comparing 22G and 25G FNB platforms is lacking. We aimed to prospectively assess the performance of 22G and 25G Franseen tip core biopsy needles in the sampling of solid pancreatic lesions. METHODS: Consecutive patients were enrolled between 2017 and 2018 and underwent EUS-FNB sampling of solid pancreatic lesions at Indiana University Hospital using 2 needle sizes: 25G (Study group) and 22G (Control group) Acquire needles (Boston Scientific Co., Natick, MA, USA). The endosonographer chose the needle size based on lesion location and characteristics. Tissue specimens were handled in a standardized fashion using onsite evaluation, touch and smear preparation, and cell block tissue collection. Specimens were independently evaluated by 2 expert cytopathologists blinded to the diagnosis in each case. They assessed cytological yield (on smears) and histologic yield (on cellblock) using a previously validated standard scoring system reached by a consensus among our cytopathologists. RESULTS: A total of 75 patients (42 males, median age = 65 years) with solid pancreatic lesions underwent EUS-FNB during the study period: 50 using a 25G and 25 using 22G needle. There was no significant difference in the size or final cytopathological diagnosis of the lesions between the 2 groups (Table 1). Similarly, cytological scores of smears were comparable between the 2 groups. Due to the 25G needle’s increased flexibility in locations that entailed excessive scope angulation, it was utilized more for lesion sampling in the pancreatic head and uncinate process (70% vs 52%, P = 0.012). There was a statistically significant increase in diagnostic yield seen in the 25G group compared to the 22G (98% vs 88%. P = 0.013). The number of passes for cytological smears between both groups were similar; however, the 25G group required additional passes to obtain an adequate cell-block (1.6 vs 0.4, P = 0.001). CONCLUSION: We found the 25G FNB needle to be associated with superior diagnostic adequacy over 22G needles. This is consistent with FNA literature comparing these two common needle sizes. We noted an increased number of passes required in the 25G group to develop a cell block. This is likely due to the smaller size needle requiring more passes to build up an adequate cell block.

A prospective, randomized, multicenter clinical trial comparing 25-gauge and 20-gauge biopsy needles for endoscopic ultrasound-guided sampling of solid pancreatic lesions.

Various core biopsy needles have previously been developed for endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). However, the properties of needle gauge in the diagnostic outcomes of solid pancreatic lesions remain unknown. This trial compared the procurement rates of histologic cores from solid pancreatic lesions with EUS-FNB using 20- and 25-gauge (G) FNB needles. In a prospective randomized multicenter clinical trial, patients with solid pancreatic lesions underwent EUS-FNB with either a 20-gauge or a 25-gauge FNB needle. The rates of histologic core procurement, overall diagnostic accuracy, and adverse events were compared between the two groups (20-gauge or 25-gauge FNB needle). In total, 88 patients (48 men, 40 women, mean age 65.7years) were enrolled. No significant differences were found in the demographic characteristics between the two groups (20-gauge or 25-gauge FNB needle). The procurement rate of histologic cores in the 20-guage FNB needle group (41/45, 91.1%) was significantly higher than that in the 25-guage FNB needle group (32/43, 74.4%, P = 0.037). However, no significant differences were found in the overall diagnostic accuracy between 20-guage FNB needle (40/45, 88.9%) and 25-guage FNB needle (34/43, 79.1%, P = 0.208). No procedure-related adverse events were observed in either group. Although both FNB needles provided high overall diagnostic accuracy, the reliability of the 20-guage FNB needle is better than the 25-guage FNB needle when retrieving samples for histological analysis.

Histologic retrieval rate of a newly designed side-bevelled 20G needle for EUS-guided tissue acquisition of solid pancreatic lesions.

Innovative approaches to improve diagnostic yield of endoscopic ultrasound-guided tissue acquisition (EUS-TA) have focused on needle design with development of fine-needle biopsy (FNB) needles with microcore-acquisition technology. Recently, a 20-gauge (20G) antegrade-cutting-side-bevelled biopsy needle (ProCore®) was developed for EUS-TA, but data about its diagnostic performance and histological capability are scant. We assessed the diagnostic performance and histologic retrieval rate of a new 20G antegrade-cutting-side-bevelled biopsy needle compared with a 22G reverse-side-bevelled needle for EUS sampling of solid pancreatic lesions. A retrospective analysis of 238 consecutively collected patients who underwent EUS-TA using a 20G or a 22G ProCore® needle, without rapid on-site evaluation (ROSE), was conducted at two centres.Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Histologic tissue retrieval was evaluated applying a scoring system for each case. Sensitivity and specificity were estimated as 98.4-100% in the 20G-, and 94.9-100% in the 22G-needle groups, respectively (p > 0.99). The 20G procured more histologic-grade tissues (92.6% vs 49.5%, p < 0.0001) achieved by a lower number of passes (2.64 vs 3.44, p < 0.0001) compared to the 22G. Both side-bevelled FNB needles achieved a high diagnostic sensitivity. The 20G-side-bevelled needle obtained a significantly higher microcore retrieval rate.

A Multicenter comparative trial of a novel EUS-guided core biopsy needle (SharkCore™) with the 22-gauge needle in patients with solid pancreatic mass lesions.

Background and Objectives:The ability to obtain adequate tissue of solid pancreatic lesions by EUS-guided remains a challenge. The aim of this study was to compare the performance characteristics and safety of EUS-FNA for evaluating solid pancreatic lesions using the standard 22-gauge needle versus a novel EUS biopsy needle.Methods:This was a multicenter retrospective study of EUS-guided sampling of solid pancreatic lesions between 2009 and 2015. Patients underwent EUS-guided sampling with a 22-gauge SharkCore (SC) needle or a standard 22-gauge FNA needle. Technical success, performance characteristics of EUS-FNA, the number of needle passes required to obtain a diagnosis, diagnostic accuracy, and complications were compared.Results:A total of 1088 patients (mean age = 66 years; 49% female) with pancreatic masses underwent EUS-guided sampling with a 22-gauge SC needle (n = 115) or a standard 22-gauge FNA needle (n = 973). Technical success was 100%. The frequency of obtaining an adequate cytology by EUS-FNA was similar when using the SC and the standard needle (94.1% vs. 92.7%, respectively). The sensitivity, specificity, and diagnostic accuracy of EUS-FNA for tissue diagnosis were not significantly different between two needles. Adequate sample collection leading to a definite diagnosis was achieved by the 1st, 2nd, and 3rd pass in 73%, 92%, and 98% of procedures using the SC needle and 20%, 37%, and 94% procedures using the standard needle (P < 0.001), respectively. The median number of passes to obtain a tissue diagnosis using the SC needle was significantly less as compared to the standard needle (1 and 3, respectively; P < 0.001).Conclusions:The EUS SC biopsy needle is safe and technically feasible for EUS-FNA of solid pancreatic mass lesions. Preliminary results suggest that the SC needle has a diagnostic yield similar to the standard EUS needle and significantly reduces the number of needle passes required to obtain a tissue diagnosis.

The accuracy and clinical impact of endoscopic ultrasound-guided dual needle sampling in solid pancreatic lesions

Background and Objectives:Different tissue entities can present as solid pancreatic lesions (SPLs). This study aimed to explore the diagnostic accuracy of endoscopic ultrasound-guided dual needle sampling (endoscopic ultrasound-guided fine needle aspiration/biopsy [EUS-FNA/B]) in SPLs.Methods:In 2012-2016, consecutive patients with SPLs were prospectively included in a single-center setting aiming at dual sampling with EUS-FNA (22/25-gauge) and reverse bevel EUS-FNB (22-gauge) in each lesion. Randomization decided if the first pass should be EUS-FNA or EUS-FNB. The primary outcome was the diagnostic accuracy including mandatory immunostaining of all tumors but pancreatic ductal adenocarcinoma (PDAC). The secondary outcome was the clinical impact of dual needle sampling EUS-FNA/B in comparison with single needle EUS-FNA of SPLs performed in the same center 2006-2011 (the comparison cohort).Results:In 108 study subjects, 68 dual needle sampling procedures were performed. The four most common entities were PDAC (32%), neuroendocrine tumor (34%), pancreatitis (15%), and metastasis (6%). EUS-FNA and EUS-FNB had comparable diagnostic accuracy. EUS-FNA/B, compared with EUS-FNA, had a higher sensitivity for malignancy (91% vs. 75%, P = 0.004), higher sensitivity for non-PDAC malignancy (89% vs. 69%, P=0.02), and higher overall accuracy (91% vs. 78%, P=0.004). The performance of an additional diagnostic procedure was less frequent after EUS-FNA/B compared with EUS-FNA of the comparison cohort (4% vs. 21%, P=0.007).Conclusions:Reverse bevel EUS-FNB is not superior to EUS-FNA in the sampling of solid pancreatic lesions. However, dual needle sampling with both modalities (EUS-FNA/B) seems to improve the diagnostic accuracy and facilitate the clinical management, especially in malignant entities other than ductal adenocarcinomas.

Su1323 Diagnostic Accuracy of 22/25-Gauze Core Needle in Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: Systematic Review and Meta-Analysis

Su1323 Diagnostic Accuracy of 22/25-Gauze Core Needle in Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: Systematic Review and Meta-Analysis

Su1316 Sharkcore™ Biopsy Needle Provides Increased Cytopathological Yield for EUS Guided Sampling of Solid Pancreatic Lesions. a Single Center Experience

Su1316 Sharkcore™ Biopsy Needle Provides Increased Cytopathological Yield for EUS Guided Sampling of Solid Pancreatic Lesions. a Single Center Experience

Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using standard needles has a high diagnostic value in the evaluation of solid pancreatic masses. Fenestrated needles have been developed to improve the quality of EUS-guided tissue sampling by providing core biopsies (FNB). Patients with solid pancreatic masses of >2 cm were prospectively included in our study and randomized to receive EUS sampling, using either a standard 22G FNA or a 22G Procore® FNB needle. The main study endpoint was the number of needle passes required to obtain a diagnosis in more than 90% of cases. We included 100 patients (male = 63, female = 37; mean age = 68.4 years) in our study. We found that 88% of the lesions were malignant, with a mean size of 32 mm. A sample adequate for diagnosis was obtained in more than 90% of cases after the second needle pass in the FNB group, versus the third needle pass in the FNA group. Slide cellularity and presence of tissue microfragments were significantly higher in the FNB group. Sensitivity for the diagnosis of malignancy was 88.4% versus 97.8% for the EUS-FNA and EUS-FNB group, respectively, while specificity for both techniques was 100%. No complications were recorded. Although the accuracy of both needle types for proving malignancy was similar, a lower number of passes was required with the FNB needles to achieve the same contributive sample rate as with the FNA needles. FNB also improved the histopathological quality of specimens, suggesting an overall superiority of FNB sampling.

PWE-008 Multicentre randomised trial comparing eus guided fine needle aspiration cytology (fnac) with fine needle aspiration biopsy (fna b) in sampling solid pancreatic mass lesions: preliminary results from the procore trial

Introduction EUS-guided FNA is the standard of care for tissue sampling of pancreatic lesions. The new Echo Tip ProCore biopsy needle (Cook Medical) was developed to obtain core tissue specimens for histological analysis improving the diagnostic yield and potentially obviating the need for onsite cytopathologist. Our aim was to compare the standard Echo tip ultra FNAC needle with the new Echo Tip Ultra ProCore FNAB needle in the sampling of solid pancreatic lesions. Method Randomised multicenter trial (REC Ref 12/EM/0189). All patients referred for EUS-guided tissue sampling of a solid pancreatic mass were invited to participate. Linear EUS (Aloka-Olympus/Hitachi-Pentax) was performed and patients were randomised to either FNAC or FNAB. Due to the nature of the study the endoscopist could not be blinded. A 22G needle was used when sampling from the stomach and a 25G from the duodenum. A maximum of 5 passes were allowed. Sampling time from first insertion of the needle into the lesion to the time the last tissue sample is transferred into the histology pot, number of passes and adequacy for diagnosis were recorded and included for analysis. Immediate and delayed complications were also recorded. Results 266 patients were recruited (median age 67 years, 52% men); 142 randomised to the FNAC group and 124 to the FNAB group. Two patients were excluded after randomization; no mass lesion was seen in 1 patient randomised to FNAC and the needle failed in 1 patient in the FNAB group and FNAC was performed. 264 patients were analysed, 141 in the FNAC group (22G=83 and 25G=58. Median max diameter of the lesion 34 mm, range 10–87 mm) and 123 in the FNAB group (22G=53 and 25G=71. Median max diameter 33 mm, range 8–85 mm). There was no statistical significant difference between groups in number of passes (median 4, range 1–5 in the FNAC group vs. median 3, range 1–5 in the FNAB group, p = 0.12), sampling time (median 13 min, range 1–32 min vs. median 13 min, range 2–42 min, p = 0.63) and adequacy of the specimen for diagnosis (90.8% vs. 87%, p = 0.33). Three technical failures were observed in the FNAB group and none in the FNAC cohort (1.6% vs. 0%, p = 0.99). No complications reported in either group. Conclusion FNAC and FNAB needles were comparable in terms of sampling time, number of passes, sample adequacy for diagnosis and safety. Technical failure was higher in the FNAB arm but not statistically significant. Disclosure of interest None Declared.

Tu1643 A Prospective Comparison Study of a Standard 25-Gauge Needle With a 22-Gauge Core Needle Using Standard Suction and Capillary Suction Technique for Cytologic and Histologic EUS-Guided Sampling of Solid Pancreatic Lesions

Tu1643 A Prospective Comparison Study of a Standard 25-Gauge Needle With a 22-Gauge Core Needle Using Standard Suction and Capillary Suction Technique for Cytologic and Histologic EUS-Guided Sampling of Solid Pancreatic Lesions