Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2181
Peer-review started: December 27, 2022
First decision: January 22, 2023
Revised: January 28, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: April 6, 2023
Processing time: 92 Days and 20.6 Hours
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis. Recently, macroscopic on-site evaluation (MOSE) performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB. The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB. Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms. Therefore, this challenging diagnosis is based on endoscopy, imaging, and the bacteriological and histological examination of tissue biopsies. This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer. EUS-FNB can be very useful in providing a valuable histopathological diagnosis. A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis, leading to the request of the GeneXpert, which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin. A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.
Core Tip: In this article, we discussed the role of endoscopic ultrasound with fine-needle biopsy as a diagnostic tool in patients with suspicious pancreatic tuberculosis. This review aims to provide knowledge on the utility of fine-needle biopsy and macroscopic on-site evaluation of the core to suspect pancreatic tuberculosis, in addition to diverting the attention of the endoscopists to consider tuberculosis when the core is cheesy.