Published online Nov 16, 2019. doi: 10.4253/wjge.v11.i11.531
Peer-review started: March 18, 2019
First decision: May 9, 2019
Revised: September 25, 2019
Accepted: October 18, 2019
Article in press: October 18, 2019
Published online: November 16, 2019
Processing time: 242 Days and 3.5 Hours
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.
To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.
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.
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.
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.
Core tip: Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains a challenge. Endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps was recently used to make a definitive diagnosis of PCLs. The aim of this study was to assess the safety and efficacy of EUS-TTNB compared with EUS-fine-needle aspiration (FNA), and feasibility of intrapapillary mucinous neoplasm (IPMN) subtyping using EUS-TTNB specimen. Fifty-six patients underwent EUS-TTNB. The rates of technical success, clinical success, and adverse events were 100%, 80.4% and 3.6%, respectively. The clinical success rate was higher in EUS-TTNB (80.4%) than in EUS-FNA (15%). IPMN subtyping was successful in 71.9% (23/32) in patients with IPMN.