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World J Gastroenterol. Jul 14, 2021; 27(26): 4194-4207
Published online Jul 14, 2021. doi: 10.3748/wjg.v27.i26.4194
Endoscopic ultrasound fine needle aspiration vs fine needle biopsy for pancreatic masses, subepithelial lesions, and lymph nodes
Irving Levine, Arvind J Trindade
Irving Levine, Arvind J Trindade, Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY 11040, United States
Author contributions: Levine I and Trindade AJ contributed equally to this work; Levine I and Trindade AJ designed the research study; Levine I and Trindade AJ performed the research; Levine I and Trindade AJ analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Trindade AJ has received research funding from Ninepoint Medical. Trindade AJ is a consultant for Pentax Medical and Olympus America.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arvind J Trindade, MD, Associate Professor, Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 270-05 76th Avenue, New Hyde Park, NY 11040, United States. arvind.trindade@gmail.com
Received: February 26, 2021
Peer-review started: February 26, 2021
First decision: April 18, 2021
Revised: April 28, 2021
Accepted: June 18, 2021
Article in press: June 18, 2021
Published online: July 14, 2021
Processing time: 135 Days and 3.4 Hours
Abstract

Endoscopic ultrasound tissue acquisition, in the form of both fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), is utilized for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA has potential limitations associated with cytological aspirations, including inability to determine histologic architecture, and a small quantitative sample for further immunohistochemical staining. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. However, it remains unclear which technique should be used and for which lesions. Comparative trials are plagued by heterogeneity at every stage of comparison; including variable needles used, and different definitions of endpoints, which therefore limit generalizability. Thus, we present a review of prospective trials, systematic reviews, and meta-analyses on studies examining EUS-FNA vs EUS-FNB. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions, and yield conflicting results in terms of demonstrating the superiority of one method. However, consistent among trials is the potential for diagnosis with fewer passes, and a larger quantity of sample achieved for next generation sequencing. With regard to subepithelial lesions and lymph node biopsy, fewer prospective trials exist, and larger prospective studies are necessary. Based on the available literature, we would recommend EUS-FNB for peri-hepatic lymph nodes.

Keywords: Endoscopic ultrasound fine needle aspiration; Endoscopic ultrasound fine needle biopsy; Pancreatic lesions; Subepithelial lesions; Lymph node biopsy

Core Tip: Endoscopic ultrasound fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB) provide two methods for endoscopic ultrasound tissue acquisition for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both methods are safe and provide high diagnostic yield. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic lesions. EUS-FNB provides diagnostic accuracy with fewer needle passes, and may provide higher diagnostic yield for peri-hepatic lymph nodes.