Endosonographic diagnosis of advanced neoplasia in intraductal papillary mucinous neoplasms

Table 2 Comparison of endoscopic ultrasound-guided microforceps biopsy to resected specimen[23]

Ref.	Design	Sample	Specific cyst type (MFB/surgery)					Results	Additional key findings
			IPMN-Ca	IPMN-HGD	IPMN-LGD	MCN-HG	MCN-LG
Basar et al[51], 2018	Retrospective, open label, multicenter; MFB	n = 42 patients; n = 7 surgical pathology	2/2	0/0	1/1	-	0/1	Cystic tissue acquisition yield 90% MFB vs 88.1% FNA. Diagnostic yield was 61.9% MFB vs 47.6% CFC	Specific cyst type diagnosis provided by MFB 35.7% vs CFC 4.8%
Kovacevic et al[31], 2018	Retrospective, MFB	n = 31 patients; n = 18 FNA cytology; n = 4 surgical pathology	0/1	0/0	31/2	-	-	Technical success for MFB 87.1% vs 58.1% FNA. Diagnostic yield 71% MFB vs 35.5% CFC	MFB yielded change in clinical management in 19.4% of cases
Mittal et al[52], 2018	Retrospective, EUS-MFB	n = 27 patients	0/0	0/0	12/3	NA	NA	Technical success 100% EUS-MFB; Diagnostic yield 88.9% EUS-MFB	MFB altered diagnosis in 26% of cases. However, cytology diagnosed 4 mucinous cysts (14.8%) that MFB missed
Yang et al[53], 2018	Retrospective, EUS-MFB	n = 47 patients; n = 8 surgical pathology	0/0	2/2	43/5	-	-	Technical success EUS-MFB 85.1% vs 48.9% FNA	Mucinous cysts were diagnosed more often by EUS-MFB (34.3%) compared to FNA + CEA analysis combined (9.4%); FNA diagnosed adenocarcinoma for 1 patient, but was benign via EUS-MFB and surgical resection
Zhang et al[54], 2018	Retrospective, MFB	n = 48 patients	14/3	11/0	4/4	-	0/1	Diagnostic yield MFB 75.0% vs 72.9% CFC	Specific cyst type diagnosis was successful 50.0% MFB vs 18.8% for FNA cytology; Three times as many IPMNs were diagnosed by MFB alone compared to CFC
Crinò et al[55], 2019	Retrospective, EUS-MFB	n = 61 patients	-	-	-	0/1	11/12	Diagnostic reliability of EUS-MFB compared to surgery was 90% vs 20% CFC	Two EUS-MFB histologic samples resulted in a specific cyst diagnosis in 74% of cases; 100% histological adequacy reached with two EUS-MFB samples
Yang et al[24], 2019	Prospective, Open Label, EUS-MFB	n = 114 patients; n = 23 surgical pathology	2/2	2/2	5/5	3/3	1/1	Specificity for EUS-MFB was 100% vs 21.4% CFC; EUS-MFB was diagnostic to the degree of dysplasia by 80% vs 0% CFC	Tissue acquisition reached 83.3% with EUS-MFB vs 37.7% with FNA; Findings from EUS-MFB were 100% concordant with analysis from resection vs 21.4% with CFC alone

¹False negative by micro-forceps biopsy, surgery identified as adenocarcinoma.

²Cysts classified as mucinous, but not differentiated into intraductal papillary mucinous neoplasm or mucinous neoplasm.

³Intraductal papillary mucinous neoplasms with no dysplasia subtype were grouped as intraductal papillary mucinous neoplasm low-grade dysplasia.

⁴Undiagnostic on micro-forceps biopsy. IPMNs: Intraductal papillary mucinous neoplasms; IPMN-Ca: IPMN with adenocarcinoma; HGD: High-grade dysplasia; LGD: Low-grade dysplasia; MFB: Micro-forceps biopsy; CFC: Cystic fluid cytology; FNA: Fine needle aspiration; MCN: Mucinous neoplasm; NA: Not available.