Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2019; 11(11): 531-540
Published online Nov 16, 2019. doi: 10.4253/wjge.v11.i11.531
Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
Rintaro Hashimoto, John G Lee, Kenneth J Chang, Nabil El Hage Chehade, Jason B Samarasena
Rintaro Hashimoto, John G Lee, Kenneth J Chang, Nabil El Hage Chehade, Jason B Samarasena, H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, Orange, CA 92868, United States
Author contributions: All authors helped to perform the research; Hashimoto R manuscript writing, performing procedures and data analysis; Lee JG and Chang KJ performing procedures; El Hage Chegade N manuscript writing; Samarasena JB contribution to performing procedures and drafting conception.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of University of California Irvine Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No financial support was received from the company of microforceps to conduct this study. Dr Samarasena is a consultant to US Endoscopy. None of the other authors have any relevant conflicts of interest.
Data sharing statement: No data is shared.
STROBE statement: All the statement is checked.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Rintaro Hashimoto, MD, PhD, Doctor, H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, 333 City Blvd West, Suite 400, Orange, CA 92868, United States. rintaroh@uci.edu
Telephone: +1-714-4566745 Fax: +1-714-4567753
Received: March 18, 2019
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
Abstract
BACKGROUND

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.

AIM

To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Pancreatic cyst lesion, Endoscopic ultrasound, Endoscopic ultrasound-guided fine needle aspiration, Cyst fluid, Biopsy

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.