Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

Rintaro Hashimoto; John G Lee; Kenneth J Chang; Nabil El Hage Chehade; Jason B Samarasena

doi:10.4253/wjge.v11.i11.531

Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

World J Gastrointest Endosc. 2019 Nov 16;11(11):531-540. doi: 10.4253/wjge.v11.i11.531.

Authors

Rintaro Hashimoto¹, John G Lee², Kenneth J Chang², Nabil El Hage Chehade², Jason B Samarasena²

Affiliations

¹ H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, Orange, CA 92868, United States. rintaroh@uci.edu.
² H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, Orange, CA 92868, United States.

Abstract

Background: Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps in PCLs has been made available.

Aim: To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.

Methods: We retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration (FNA) for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis.

Results: A total of 56 patients (mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8 mm (12-85 mm). The EUS-TTNB procedure was technically successful in all patients (100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA, respectively 80.4% (45/56) vs 25% (14/56). Adverse events occurred in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Using TTNB specimens, 23 of 32 cases (71.9%) with intraductal papillary mucinous neoplasm were further differentiated into gastric type (19 patients) and pancreaticobiliary type (4 patients) based on immunochemical staining.

Conclusion: EUS-TTNB for PCLs was technically feasible and had a favorable safety profile. Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen. EUS-TTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.

Keywords: Biopsy; Cyst fluid; Endoscopic ultrasound; Endoscopic ultrasound-guided fine needle aspiration; Pancreatic cyst lesion.