Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2024; 16(11): 595-606
Published online Nov 16, 2024. doi: 10.4253/wjge.v16.i11.595
Role of macroscopic on-site evaluation of endoscopic ultrasound-guided fine-needle aspiration/biopsy: Results of a multicentric prospective study
Hussein H Okasha, Hiwa A Hussein, Khaled M Ragab, Omar Abdallah, Fedoua Rouibaa, Borahma Mohamed, Fahd Ghalim, Mahmoud Farouk, Mohamed Lasheen, Mohamed A Elbasiony, Ahmed E Alzamzamy, Ahmed El Deeb, Hassan Atalla, Mahmoud El-Ansary, Sahar Mohamed, Moaz Elshair, Wafaa Khannoussi, Mohamed Z Abu-Amer, Amine Elmekkaoui, Mohammed S Naguib, Adil Ait Errami, Ahmed El-Meligui, Ahmed H El-Habashi, Mahmoud G Ameen, Dalia Abdelfatah, Mona Kaddah, Hanane Delsa
Hussein H Okasha, Ahmed El-Meligui, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
Hiwa A Hussein, Sulaimani Center for Advanced Gastrointestinal Endoscopy, Sulaimani College of Medicine, Sulaymaniyah 46001, Iraq
Khaled M Ragab, Mohamed Lasheen, Mahmoud El-Ansary, Department of Hepatology and Gastroenterology, Theodor Bilharz Research Institute, Cairo 11211, Egypt
Omar Abdallah, Hepatology and Gastroenterology Unit, Department of Internal Medicine, Mansoura University, Faculty of Medicine, Mansoura 35516, Egypt
Fedoua Rouibaa, Gastrointestinal Endoscopy Center, Military Hospital Mohamed V, Faculty of Medicine of Rabat, Rabat 10100, Rabat-Salé-Kénitra, Morocco
Borahma Mohamed, Department of Gastroenterology “C”, Ibn Sina Hospital, Mohammed V University in Rabat, Rabat 10000, Rabat-Salé-Kénitra, Morocco
Fahd Ghalim, Digestive Endoscopy Unit, Mekka Clinic, Casablanca 20000, Casablanca-Settat, Morocco
Mahmoud Farouk, Department of Tropical Medicine and Gastroenterology, Luxor University, Luxor 85951, Egypt
Mohamed A Elbasiony, Hassan Atalla, Hepatology and Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
Ahmed E Alzamzamy, Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11841, Egypt
Ahmed El Deeb, Sahar Mohamed, Department of Gastroenterology, National Hepatology and Tropical Medicine Research Institute, Cairo 12556, Egypt
Moaz Elshair, Mohamed Z Abu-Amer, Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt
Wafaa Khannoussi, Hanane Delsa, Department of Gastroenterology and Endoscopy Center, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Casablanca-Settat, Morocco
Wafaa Khannoussi, Hanane Delsa, Research Unit, Mohammed VI Center for Research and Innovation, Rabat 10100, Rabat-Salé-Kénitra, Morocco
Amine Elmekkaoui, Department of Hepato-Gastroenterology, Hassan II University Hospital of Fez, Faculty of Medicine, Pharmacy and Dentistry of Fez, Sidi Mohamed Ben Abdellah University, Fes 30003, Fès-Meknès, Morocco
Mohammed S Naguib, Department of Gastroenterology, Ahmed Maher Teaching Hospital, Cairo 11451, Egypt
Adil Ait Errami, Department of Gastroenterology, Cadi Ayyad University, Mohammed VIth University Hospital, Marrakech 40000, Morocco
Ahmed H El-Habashi, Department of Pathology, National Cancer Institute, Cairo University, Cairo 11451, Egypt
Mahmoud G Ameen, Oncological Pathology, South Egypt Cancer Institute, Assiut University, Assiut 71516, Egypt
Dalia Abdelfatah, Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11451, Egypt
Mona Kaddah, Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
Author contributions: Okasha HH and Delsa H participated in the design and oversight of the study, were involved with data collection, and drafted the manuscript; Kaddah M assisted with data analysis and contributed to the manuscript draft; Abdelfatah D performed the statistics; Hussein HA, Ragab KM, Abdallah O, Rouibaa F, Mohamed B, Ghalim F, Farouk M, Lasheen M, Elbasiony MA, Alzamzamy AE, El Deeb A, Atalla H, El-Ansary M, Mohamed S, Elshair M, Khannoussi W, Abu-Amer MZ, El Mekkaoui A, Naguib MS, Ait Errami A, El-Meligui A, El-Habashi AH, and Ameen MG were involved with data collection, drafted the manuscript, and assisted with data analysis; and all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Research Ethics Committee of Cairo University (MD-319-2022).
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hanane Delsa, MD, Associate Professor, Department of Gastroenterology and Endoscopy Center, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Avenue Mohamed Taieb Naciri, Casablanca 82403, Casablanca-Settat, Morocco. dr.delsa.hanane@gmail.com
Received: May 20, 2024
Revised: September 20, 2024
Accepted: October 15, 2024
Published online: November 16, 2024
Processing time: 162 Days and 6.5 Hours
Abstract
BACKGROUND

The concept of macroscopic on-site evaluation (MOSE) was introduced in 2015 when the endoscopist observed better diagnostic yield when the macroscopically visible core on MOSE was superior to 4 mm. Recent studies suggest that MOSE by the endoscopist may be an excellent alternative to rapid on-site evaluation, and some classifications have been published. Few studies have assessed the adequacy of histologic cores in MOSE during endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB).

AIM

To evaluate the performance of MOSE during EUS-FNA/FNB.

METHODS

This multicentric prospective study was conducted in 16 centers in 3 countries (Egypt, Iraq, and Morocco) and included 1108 patients with pancreatic, biliary, or gastrointestinal pathology who were referred for EUS examination. We prospectively analyzed the MOSE in 1008 patients with available histopathological reports according to 2 classifications to determine the adequacy of the histological core samples. Data management and analysis were performed using a Statistical Package for Social Sciences (SPSS) version 27.

RESULTS

A total of 1074 solid lesions were biopsied in 1008 patients with available cytopathological reports. Mean age was 59 years, and 509 patients (50.5%) were male. The mean lesion size was 38 mm. The most frequently utilized needles were FNB-Franseen (74.5%) and 22 G (93.4%), with a median of 2 passes. According to 2 classifications, 618 non-bloody cores (61.3%) and 964 good samples (95.6%) were adequate for histological evaluation. The overall diagnostic yield of cytopathology was 95.5%. The cytological examination confirmed the diagnosis of malignancy in 861 patients (85.4%), while 45 samples (4.5%) were inconclusive. Post-procedural adverse events occurred in 33 patients (3.3%). Statistical analysis showed a difference between needle types (P = 0.035) with a high sensitivity of FNB (97%). The analysis of the relationship between the MOSE-score and the final diagnosis showed a significant difference between the different scores of the MOSE (P < 0.001).

CONCLUSION

MOSE is a simple method that allows endoscopists to increase needle passes to improve sample quality. There is significantly higher FNB sensitivity and cytopathology diagnostic yield with good MOSE cores.

Keywords: Macroscopic on-site evaluation; Fine-needle aspiration; Fine-needle biopsy; Endoscopic ultrasound; Specimen adequacy

Core Tip: This work is a multicentric international prospective study of 1108 patients to evaluate macroscopic on-site evaluation (MOSE) performance in endoscopic ultrasound-guided fine-needle aspiration/biopsy for diagnostic accuracy. MOSE is a simple procedure that allows the endoscopist to increase the number of needle passes to improve sample quality. The current study confirmed the relationship between good cores by MOSE scoring and a high diagnostic yield in cytopathology and showed a higher sensitivity of fine-needle biopsy (97%).