Post written by Kosuke Takahashi, MD, PhD, from the Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan, and Ichiro Yasuda, MD, PhD, from the Third Department of Internal Medicine, University of Toyama, Toyama, Japan.

In this study, a novel EUS-guided fine-needle biopsy sampling (EUS-FNB) needle enabled physicians to obtain sufficient pathologic samples with fewer to-and-fro movements (TAFs) within the lesion.

We compared the diagnostic yields of EUS-FNB with 3 and 12 TAFs at each puncture pass. Diagnostic sensitivity for malignancy of 3 TAFs (88.6%) was not inferior to that of 12 TAFs (89.5%; difference, –.9%; 95% confidence interval, –9.81 to 7.86). Diagnostic accuracy for malignancy was 92.7% for 3 TAFs and 94.6% for 12 TAFs.

The 3-TAF group had a significantly higher rate of score ≥3 on macroscopic visual quality evaluation than the 12-TAF group (71.8% vs 52.7%, P = .009). Diagnostic sensitivity and accuracy of EUS-FNB with 3 TAFs were not inferior to those with 12 TAFs for solid pancreatic lesions. The 3-TAF group showed significantly less blood contamination in sampled tissues than the 12-TAF group.

We believe that just 3 TAFs would be enough to obtain histopathologic samples. Using fewer TAFs to obtain samples would reduce the procedure time and improve the quality of histopathologic specimens by decreasing blood contamination in the biopsy samples.

Furthermore, a high number of TAFs would theoretically increase the risk of adverse events because of cellular damage. Therefore, fewer TAFs might reduce the histologic damage associated with puncture and lead to decreased potential adverse events.

The diagnostic sensitivity and accuracy of EUS-FNB with 3 TAFs were comparable with that of 12 TAFs. These results suggest that an adequate tissue sample could be obtained with 3 TAFs during EUS-FNB using a Franseen needle (22-gauge Acquire; Boston Scientific Corporation, Marlborough, Mass, USA) for solid pancreatic lesions. The higher score of the 3-TAF group in the macroscopic quality evaluation suggested less blood contamination in the sample.

Such reduced blood contamination in the samples can facilitate macroscopic on-site evaluation. This also may be helpful for the pathologist because blood contamination can disturb pathologic interpretation.

In addition, fewer TAFs can reduce the procedure time and the risk of blood leakage from the puncture site.

Graphical Abstract

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