Efficacy of 3 fine-needle biopsy techniques for suspected pancreatic malignancies

Post written by Tae Hoon Lee, MD, PhD, from the Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Korea.Lee_headshot

EUS-guided fine-needle aspiration/biopsy (EUS-FNA/B) has a high diagnostic accuracy for pancreatic tumors. However, the ability of various FNA/B techniques to obtain an adequate mass of cells or tissue has rarely been investigated, especially in the absence of rapid on-site cytologic evaluation (ROSE). If ROSE is not available, use of a standard technical tip for acquisition of adequate sample may be important for confirmatory diagnosis.

Usually, the availability of on-site cytopathologists is limited by cost and staffing issues in many hospitals. We showed comparative results obtained by EUS-FNB using the stylet slow-pull-back technique, conventional negative-suction technique, and non-suction technique in terms of diagnostic yield and specimen adequacy by degree of cellularity and blood contamination in the absence of ROSE. Therefore, our results may provide an adequate EUS-FNA/B method for diagnosis of pancreas tumor in the absence of ROSE.

In our study, the slow-pull-back technique obtained samples with greater cellularity and less blood contamination compared with the other 2 techniques. However, the core-tissue acquisition rate did not differ among the 3 techniques. A blood contamination was more prevalent in the negative suction group. Compared with the non-suction technique, the negative suction technique did not increase the rate of core-tissue acquisition. Pooling the results from the 3 techniques increased the rate of diagnosis.

Lee_fig

Figure 1. Cytologic specimens for cellularity. A, Grade 1, fair, number of cell nest <10; B, grade 2, good, number of cell nest 10-20; C, grade 3, excellent cellularity, number of cell nest >20 (H&E, orig. mag. ×40).

Therefore, in the absence of ROSE, the stylet slow-pull-back technique might enable acquisition of tissue and assessment of cellularity for the diagnosis of pancreatic tumors suspected to be malignant. Further large-scale studies using different needles are needed to verify our results.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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