Murabayashi T, Yamada R, Kawaguchi S, Nose K, Satoh T, Nakagawa H. Impact of rapid on-site evaluation in endoscopic ultrasound-guided tissue acquisition for resectable pancreatic body and tail cancer. World J Gastrointest Endosc 2026; 18(9): 124435 [DOI: 10.4253/wjge.124435]
Corresponding Author of This Article
Toji Murabayashi, MD, Department of Gastroenterology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Mie, Japan. murabayashitoji@m2.gmobb.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
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Murabayashi T, Yamada R, Kawaguchi S, Nose K, Satoh T, Nakagawa H. Impact of rapid on-site evaluation in endoscopic ultrasound-guided tissue acquisition for resectable pancreatic body and tail cancer. World J Gastrointest Endosc 2026; 18(9): 124435 [DOI: 10.4253/wjge.124435]
Toji Murabayashi, Department of Gastroenterology, Ise Red Cross Hospital, Ise 516-8512, Mie, Japan
Toji Murabayashi, Reiko Yamada, Kenji Nose, Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
Reiko Yamada, Kenji Nose, Hayato Nakagawa, Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu 514-8507, Mie, Japan
Shinya Kawaguchi, Tatsunori Satoh, Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
Hayato Nakagawa, Department of Gastroenterology, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
Author contributions: Murabayashi T conceived and designed the study, collected and analyzed the data, interpreted the results, prepared the figure and tables, and wrote the manuscript; Yamada R and Nakagawa H supervised the study and critically revised the manuscript; Kawaguchi S, Nose K, and Satoh T contributed to data acquisition and interpretation of the results. All authors critically reviewed and approved the final version of the manuscript; all authors were responsible for the decision to submit the manuscript for publication.
AI contribution statement: ChatGPT (OpenAI) was used only for proofreading and language refinement. All scientific content was verified by the authors.
Institutional review board statement: The study protocol was approved by the institutional review boards of all participating institutions. The approval number at Ise Red Cross Hospital was No. ER2024-123.
Informed consent statement: Informed consent was obtained through an opt-out approach via institutional websites.
Conflict-of-interest statement: The authors have no potential conflicts of interest.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author upon reasonable request.
Corresponding author: Toji Murabayashi, MD, Department of Gastroenterology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Mie, Japan. murabayashitoji@m2.gmobb.jp
Received: June 15, 2026 Revised: July 23, 2026 Accepted: August 26, 2026 Published online: September 16, 2026 Processing time: 87 Days and 9.9 Hours
Abstract
BACKGROUND
Needle tract seeding is a potential complication of endoscopic ultrasound-guided tissue acquisition (EUS-TA), particularly in resectable pancreatic body and tail cancer. As the transgastric needle tract is generally not resected, reducing the number of punctures may be clinically important. We hypothesized that rapid on-site evaluation (ROSE) may help minimize the number of punctures while preserving diagnostic accuracy.
AIM
To investigate whether ROSE-guided EUS-TA is associated with a low number of punctures while preserving diagnostic accuracy in this setting.
METHODS
This multicenter retrospective study included 94 patients with resectable pancreatic body or tail cancer who underwent EUS-TA with ROSE at three tertiary centers from April 2020 to September 2024. ROSE assessed malignancy for each puncture in real time. The primary outcome was the number of punctures. Cytologic diagnostic performance, per-pass ROSE concordance, positive predictive value, and negative predictive value were evaluated. Factors associated with first-pass diagnostic discrepancy were analyzed using logistic regression.
RESULTS
A total of 94 patients were included. The mean number of punctures was 1.55 ± 0.80. Overall cytologic diagnostic accuracy was 96.8% on a per-patient basis. For per-pass specimens, concordance between ROSE and the corresponding final cytologic diagnosis was 86.0% (111/129); concordance was 97.8% (90/92) when ROSE indicated malignancy and 56.8% (21/37) when ROSE indicated no malignancy. Use of fine-needle biopsy needles was independently associated with a lower risk of diagnostic discrepancy.
CONCLUSION
ROSE-guided EUS-TA showed a low mean number of punctures and high diagnostic accuracy in resectable pancreatic body and tail cancer. Controlled studies are needed to determine whether ROSE reduces punctures.
Core Tip: This multicenter retrospective study evaluated rapid on-site evaluation (ROSE) during endoscopic ultrasound-guided tissue acquisition for resectable pancreatic body and tail cancer, where needle tract seeding is a concern. The mean number of punctures was 1.55, and per-patient cytologic diagnostic accuracy remained high at 96.8%. A malignant ROSE result had a high positive predictive value, which may support termination of punctures when malignancy is identified on-site.
