Solid Pancreatic Mass Lesions Research Articles

Comparison of EUS-FNA and EUS-FNB for diagnosis of solid pancreatic mass lesions: a meta-analysis of prospective studies

Objective: To quantitatively compare the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) in solid pancreatic mass lesions using a systematic evaluation method.Methods: A systematic literature search was conducted on public databases to include studies comparing the diagnostic value of EUS-FNA and EUS-FNB in solid pancreatic mass lesions. The combined effect size was estimated using mean difference (MD) and risk difference (RD) respectively, and the corresponding 95% confidence interval (CI) was calculated.Results: The 12 articles (7 RCTs and 5 cohort studies) met the inclusion criteria of this study. The meta-analysis showed that compared with EUS-FNB, EUS-FNA had lower diagnostic accuracy (RD: −0.08, 95% CI: −0.15, −0.01) and specimen adequacy (RD: −0.08, 95% CI: −0.15, −0.02), while higher required number of needle passes (MD: 0.42, 95% CI: 0.12, 0.73). However, EUS-FNB and EUS-FNA presented similar overall complications (RD: 0.00, 95% CI: −0.01, 0.02) and technical failures (RD: −0.01, 95% CI: −0.02, 0.00), without statistically significant differences.Conclusions: Compared with EUS-FNA, EUS-FNB seems to be a better choice for diagnosing suspected pancreatic lesions.

Endobiliary biopsy.

The differential diagnosis between benign and malignant biliary strictures is challenging and requires a multidisciplinary approach with the use of serum biomarkers, imaging techniques, and several modalities of endoscopic or percutaneous tissue sampling. The diagnosis of biliary strictures consists of laboratory markers, and invasive and non-invasive imaging examinations such as computed tomography (CT), contrast-enhanced magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (EUS). Nevertheless, invasive imaging modalities combined with tissue sampling are usually required to confirm the diagnosis of suspected malignant biliary strictures, while pathological diagnosis is mandatory to decide the optimal therapeutic strategy. Although EUS-guided fine-needle aspiration biopsy is currently the standard procedure for tissue sampling of solid pancreatic mass lesions, its diagnostic value in intraductal infiltrating type of cholangiocarcinoma remains limited. Moreover, the “endobiliary approach” using novel slim biopsy forceps, transpapillary and percutaneous cholangioscopy, and intraductal ultrasound-guided biopsy, is gaining ground on traditional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography endobiliary forceps biopsy. This review focuses on the available endobiliary techniques currently used to perform biliary strictures biopsy, comparing the diagnostic performance of endoscopic and percutaneous approaches.

Fine Needle Biopsy of Solid Pancreatic Mass Lesions

Fine Needle Biopsy of Solid Pancreatic Mass Lesions

Tu1394 SLOW-PULL VERSUS SUCTION EUS-GUIDED FINE-NEEDLE ASPIRATION TECHNIQUES FOR SOLID PANCREATIC MASS LESIONS – A SYSTEMATIC REVIEW AND META-ANALYSIS

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an invaluable diagnostic tool in the management of solid pancreatic mass lesions. EUS-FNA is presently performed by a standard suction technique, however, emerging data on a new technique called the slow pull EUS-FNA has shown to have better diagnostic yield by limiting blood contamination in obtained specimens. The aim of this systematic review and meta-analysis is to compare the two EUS-FNA techniques in the diagnosis of solid pancreatic masses.

Follow-up of patients with pseudotumoral chronic pancreatitis: outcome and surveillance

Aim: to follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval.
 Methods: data obtained prospectively were analyzed in a retrospective manner. Patients with clinical evidence of chronic pancreatitis (abdominal pain in the epigastrium, steatorrhea, and diabetes mellitus), endoscopic ultrasound (EUS) criteria > 4, and EUS-fine needle aspiration (FNA) were included. A pseudotumor was defined as a non-neoplastic space-occupying lesion, a cause of chronic pancreatitis that may mimic changes typical of pancreatic cancer on CT or endoscopic ultrasound but without histological evidence. A real tumor was defined as a neoplastic space-occupying lesion because of pancreatic cancer confirmed by histology.
 Results: thirty-five patients with chronic pancreatitis were included, 26 (74.2%) of whom were men. Nine (25.7%) patients were diagnosed with PCP and two (2/35; 5.7%) patients with PCP were diagnosed with pancreatic cancer on follow-up. The time between the diagnosis of PCP and pancreatic adenocarcinoma was 35 and 30 days in the two patients. Definitive diagnosis of pancreatic adenocarcinoma was made by surgery. In the remaining six patients with PCP, the median of follow-up was 11 months (range 1–22 months) and they showed no evidence of malignancy on surveillance. In the follow-up of patients without PCP but with chronic pancreatitis, none were diagnosed with pancreatic cancer. According to our data, older patients with chronic pancreatitis are at risk of PCP.
 Conclusion: according to characteristics of patient, detection of PCP should lead a surveillance program for pancreatic cancer with EUS-FNA in < 1 month or directly to surgical resection.
 Core tip: actually, there are no clear recommendations for follow-up of patients with chronic pancreatitis and solid pancreatic mass lesions. We followed-up patients with chronic pancreatitis and solid pancreatic mass lesions and we assessed the final outcome and identified an optimal surveillance interval. We found that almost one-third of patients with chronic pancreatitis had PCP, and 22.2% had unresectable pancreatic adenocarcinoma less than 2 mo after the initial diagnosis. Endoscopic ultrasound fine needle aspiration can miss malignancy in nearly 25% of patients with PCP.

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 effect of solid pancreatic mass lesions on pancreatic duct diameter at endoscopic ultrasound.

Objectives:To evaluate the effect of solid pancreatic masses on the pancreatic duct (PD) at the endoscopic ultrasound (EUS) and the relationship of the location/size of a mass and PD dilation.Materials and Methods:Patients who underwent EUS for pancreatic indications from 2011 to 2013 at a single center were retrospectively identified. Those with biopsies that revealed adenocarcinoma or neuroendocrine tumors in the pancreas were identified and PD size was ascertained from EUS, computed tomography, or magnetic resonance imaging.Results:Of the 475 patients who had a pancreatic EUS, 239 had a dilated PD and 236 had a normal PD. Patients with a dilated PD had a significantly higher incidence of pancreatic malignancy than those with a normal PD diameter (106/239, 44.4% vs. 32/236, 13.6%, P < 0.001). Of the 138 patients with a pancreatic malignancy, 106 (76.8%) had a dilated PD at some location in the pancreas. Over 80% of patients with a mass within the head, neck, or body had a dilated PD. For a mass located at the uncinate process or the tail, PD dilation was 65% and 23%, respectively. Fifty-six (80.0%) of the masses in the head, 11 (78.6%) masses in the neck, and 16 (76.2%) masses in the body had a dilated PD upstream of the mass. In addition, a step-wise increase in the incidence of PD dilation was correlated with an increase in mass size. About 67.6% of patients with masses measuring in the 1st quartile had dilated a PD, while 77.8%, 91.0%, and 71.4% of those with masses measuring in the 2nd, 3rd, and 4th quartiles, respectively, had a dilated PD.Conclusion:PD dilation is a warning sign for pancreatic malignancies, however, small masses or masses at the uncinate process or the tail of the pancreas may not affect the size of the PD.

A Prospective Randomized Controlled Study Comparing EUS Sonopsy CY(R) and 22-gauge Biopsy Needles for Endoscopic Ultrasound-guided Fine-Needle Aspiration of Solid Pancreatic Mass Lesions.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a standard procedure for precise histological diagnosis of pancreas tumors, but it is sometimes difficult to obtain adequate specimens. EUS Sonopsy CY® is a newly designed needle with original features. This randomized study will compare the tissue collection rate of EUS Sonopsy CY® to that of a conventional needle in EUS-FNA. The major eligibility criteria are as follows: Patients with a pancreatic mass referred for EUSFNA; age 20 years, and performance status＜4. The primary outcome is the tissue collection rate. This study will elucidate the efficacy of EUS Sonopsy CY®.

Su1274 A Multicenter Comparative Trial of a Novel EUS-Guided Core Biopsy Needle (Sharkcore™) in Patients With Solid Pancreatic Mass Lesions

Su1274 A Multicenter Comparative Trial of a Novel EUS-Guided Core Biopsy Needle (Sharkcore™) in Patients With Solid Pancreatic Mass Lesions

1105 Per-Pass Analysis on the Diagnostic Yield of EUS-Guided FNA in Solid Pancreatic Mass Lesions: Analysis From a Multicenter Randomized Controlled Trial

1105 Per-Pass Analysis on the Diagnostic Yield of EUS-Guided FNA in Solid Pancreatic Mass Lesions: Analysis From a Multicenter Randomized Controlled Trial

RNA sequencing distinguishes benign from malignant pancreatic lesions sampled by EUS-guided FNA

EUS-guided FNA (EUS-FNA) is the primary method used to obtain pancreatic tissue for preoperative diagnosis. Accumulating evidence suggests diagnostic and prognostic information may be obtained by gene-expression profiling of these biopsy specimens. RNA sequencing (RNAseq) is a newer method of gene-expression profiling, but published data are scant on the use of this method on pancreas tissue obtained via EUS-FNA. The aim of this study was to determine whether RNAseq of EUS-FNA biopsy samples of undiagnosed pancreatic masses can reliably discriminate between benign and malignant tissue. In this prospective study, consenting adults presented to 2 tertiary care hospitals for EUS of suspected pancreatic mass. Tissue was submitted for RNAseq. The results were compared with cytologic diagnosis, surgical pathology diagnosis, or benign clinical follow-up of at least 1 year. Forty-eight patients with solid pancreatic mass lesions were enrolled. Nine samples were excluded because of inadequate RNA and 3 because of final pathologic diagnosis of neuroendocrine tumor. Data fromthe first 13 patients were used to construct a linear classifier, and this was tested on the final 23 patients (15 malignant and 8 benign lesions). RNAseq of EUS-FNA biopsy samples distinguishes ductal adenocarcinoma from benign pancreatic solid masses with a sensitivity of .87 (range, .58-.98) and specificity of .75 (range, .35-.96). This proof-of-principle study suggests RNAseq of EUS-FNA samples can reliably detect adenocarcinoma and may provide a new method to evaluate more diagnostically challenging pancreatic lesions.

Efficacy of contrast-enhanced harmonic endoscopic ultrasonography in the diagnosis of pancreatic ductal carcinoma.

Background/Aims:Distinguishing pancreatic ductal carcinoma (DC) from other pancreatic masses remains challenging. This study aims at evaluating the efficacy of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in the diagnosis of DC.Patients and Methods:Forty-nine patients with solid pancreatic mass lesions underwent CEH-EUS. EUS (B-mode) was used to evaluate the inner echoes, distributions, and borders of the masses. The vascular patterns of the masses were evaluated with CEH-EUS at 30–50 s (early phase) and 70–90 s (late phase) after the administration of Sonazoid®.Results:The final diagnoses included DCs (37), mass-forming pancreatitis (6), endocrine neoplasms (3), a solid pseudopapillary neoplasm (1), a metastatic carcinoma (1), and an acinar cell carcinoma (1). The sensitivity, specificity, and accuracy of the diagnoses of DC in hypoechoic masses using EUS (B-mode) were 89.2%, 16.7%, and 71.4%, respectively. The sensitivity, specificity, and accuracy for the diagnosis of DC in hypovascular masses using CEH-EUS were 73.0%, 91.7%, and 77.6% in the early phase and 83.8%, 91.7%, and 85.7% in the late phase, respectively.Conclusions:CEH-EUS for the diagnosis of DC is superior to EUS. CEH-EUS in the late phase was particularly efficacious in the diagnosis of DC.

Retraction. Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions.

Retraction. Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions.

Prospective cohort study comparing transient EUS guided elastography to EUS-FNA for the diagnosis of solid pancreatic mass lesions.

Semiquantitative EUS-elastography has been introduced to distinguish between malignant and benign pancreatic lesions. This study investigated whether semiquantitative EUS-guided transient real time elastography increases the diagnostic accuracy for solid pancreatic lesions compared to EUS-FNA. This single centre prospective cohort study included all patients with solitary pancreatic lesions on EUS during one year. Patients underwent EUS-FNA and semiquantitative EUS-elastography during the same session. EUS and elastography results were compared with final diagnosis which was made on the basis of tissue samples and long-term outcome. 91 patients were recruited of which 68 had pancreatic malignancy, 17 showed benign disease and 6 had cystic lesions and were excluded from further analysis. Strain ratios from malignant lesions were significantly higher (24.00; 8.01-43.94 95% CI vs 44.00; 32.42-55.00 95% CI) and ROC analysis indicated optimal cut-off of 24.82 with resulting sensitivity, specificity and accuracy of 77%, 65% and 73% respectively. B-mode EUS and EUS-FNA had an accuracy for the correct diagnosis of malignant lesions of 87% and 85%. When lowering the cut-off strain ratio for elastography to 10 the sensitivity rose to 96% with specificity of 43% and accuracy of 84%, resulting in the least accurate EUS-based method. This was confirmed by pairwise comparison. Semiquantitative EUS-elastography does not add substantial value to the EUS-based assessment of solid pancreatic lesions when compared to B-mode imaging.

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.

Sa1405 A Prospective Randomized Trial Comparing the 22-Gauge Needle With and Without a Side Port for Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Mass Lesions

Sa1405 A Prospective Randomized Trial Comparing the 22-Gauge Needle With and Without a Side Port for Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Mass Lesions Hirotoshi Ishiwatari*, Tsuyoshi Hayashi, Hiroshi Kawakami, Hiroyuki Isayama, Takao Itoi, Hiroyuki Hisai, Michihiro Ono, Yoko Abe, Natsuyo Yamamoto, Fumihide Itokawa, Tadashi Hasegawa Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Gastroenterology, The University of Tokyo, Tokyo, Japan; Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology, Japanese Red Cross Date General hospital, Date, Japan; Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan Background: Endoscopic ultrasound fine needle aspiration (EUS-FNA) is widely used for obtaining specimens from pancreatic mass lesions, owing to its high diagnostic accuracy, safety, and low invasiveness. However, it remains imperfect and needs modification to enable accurate diagnosis. The 22-gauge (G) fine needle aspiration (FNA) needle is widely used owing to its maneuverability. However, a 19G needle is superior in terms of tissue acquisition. To overcome this limitation, 22G FNA needles with a lateral side port have been developed. The side ports initially had a reverse beveled edge. Recently, needles with a round side port have been developed, which may reduce tissue damage and blood contamination, and improve diagnostic yield. Preliminary results have shown high diagnostic accuracy. We compared 22G FNA needles with and without a side port in pancreatic mass lesions in a multicenter prospective randomized control trial. Patients and Method: Between January and September 2013, consecutive 160 patients with a suspected solid pancreatic mass in five tertiary referral centers were enrolled. Patients were randomized to 22G FNA needle (EZ Shot 2, Olympus Medical Systems) with and without a side port groups (with and without groups, respectively). The primary endpoint was diagnostic accuracy. The secondary endpoints were adequacy of tissue acquisition and quality of the histological specimen (degree of contamination and amount of blood). Evaluations were made using a scoring system, by experienced attending pathologists, who were blinded to the clinical information, including the needle type. Results: Analysis of 158 patients (79 per group) was performed. Two patients did not undergo EUS-FNA after allocation. In four patients (three in the with group and one in the without group), EUS-FNA failed owing to difficulty of the puncture. There was no significant difference in the diagnostic accuracy rate (with group, 92.4% (73/79) vs. without group, 86.1% (68/79); P Z 0.3, Fisher’s exact test). In subgroup analysis, trainees (endosonographers with experience of fewer than 40 EUS-FNAs) had diagnostic accuracy rates of 97.4% (37/38) and 81.4% (35/43) in the with and without groups, respectively (P Z 0.03, Fisher’s exact test). Adequate samples for histological diagnosis were obtained in 61.3% (47/76) and 44.2% (34/78) of patients from the with and without groups, respectively (P Z 0.03, Fisher’s exact test). No significant difference was seen in the degree of sample contamination and amount of blood between the groups. Conclusion: There was no significant difference in diagnostic accuracy between the needle types. However, the needle with a side port allowed trainees to obtain the correct diagnosis at a higher rate. Moreover, the needle with a side port is superior for tissue acquisition.(Clinical trial registration number: UMI08120)

The 25-gauge EUS-FNA needle: Good for on-site but poor for off-site evaluation? Results of a randomized trial

When on-site cytopathology support is not available, EUS-guided fine needle aspiration (EUS-FNA) is performed for cell-block preparation to allow off-site interpretation. To identify the number of passes required to obtain a diagnostic cell block by using a 25-gauge needle for sampling pancreatic masses. Randomized trial. Tertiary care hospital. Sixty-two patients with solid pancreatic mass lesions. EUS-FNA was performed by using a 25-gauge needle. After establishing a preliminary on-site diagnosis, patients were randomized to 2 or 4 FNA passes for a cell block. A cell block was evaluated by a pathologist blinded to on-site interpretation for the presence of a tissue pellet, histological core tissue size, and diagnostic accuracy. To determine the number of passes required to obtain a diagnostic cell block with a 25-gauge FNA needle. Sixty-two patients were randomized to undergo either 2 (n = 31) or 4 (n = 31) FNA passes for a cell block. Before randomization, an on-site diagnosis was established in all 62 patients (100%). The final diagnosis was adenocarcinoma in 45 (72.6%), neuroendocrine/other tumor in 7 (11.3%), and chronic pancreatitis in 10 (16.1%). There was no difference in the presence of a tissue pellet (93.5 vs 96.8%; P = .99), the median size of the histological core (0.006 vs 0.05 mm(2); P = .12), or the presence of a diagnostic cell block (80.6 vs 80.6%; P = .99) between patients randomized to 2 or 4 FNA passes, respectively. Only pancreatic masses were evaluated. The 25-gauge FNA needle yielded a diagnostic cell block in only 81% of patients, irrespective of whether 2 or 4 FNA passes were performed. These findings have important implications for centers without on-site cytopathology services. (Clinical trial registration number NCT01809028.).

100 Multi-Center Randomized Trial Comparing the 19G and 25G Needles for EUS-Guided FNA of Large Solid Pancreatic Mass Lesions

Retrospective studies suggest that given the increased necrosis in large solid pancreatic mass lesions, more passes are required at EUS-FNA for establishing onsite diagnostic adequacy. The hypothesis of this study is that a larger gauge needle will procure more tissue than a smaller gauge needle and therefore will establish the diagnosis with fewer FNA passes.

Neoplasia in chronic pancreatitis: how to maximize the yield of endoscopic ultrasound-guided fine needle aspiration.

When performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), identifying neoplasia in the setting of chronic pancreatitis can be technically challenging. The morphology of an ill-defined mass on sonography, presence of calcifications or intervening collaterals, reverberation from a biliary stent, low yield of tissue procurement, and interpretative errors in cytopathology can result in both false-negative and false-positive results. Although these challenges cannot be completely eliminated, elastography or contrast-enhanced imaging can aid in differentiating an inflammatory mass from a neoplasm. Also, performing more passes of FNA, procuring core biopsy material, performing rapid onsite evaluation, conducting ancillary pathology studies, and even repeating the procedure on a different day can aid in improving the diagnostic performance of EUS-FNA. This review provides a concise update and offers practical tips to improving the diagnostic yield of EUS-FNA when sampling solid pancreatic mass lesions in the setting of chronic pancreatitis.

Higher rates of core tissue acquisition of EUS-guided FNB compared with EUS-guided FNS for solid pancreatic mass lesions

Higher rates of core tissue acquisition of EUS-guided FNB compared with EUS-guided FNS for solid pancreatic mass lesions