Tissue acquisition and pancreatic masses: Which needle and which acquisition technique should be used?

Abstract Background and study aims Pancreatic cancer represents the fourth most common cause of cancer-related deaths in Western countries and the need of a low-risk investigation to obtain an accurate histopathological diagnosis has become increasingly pressing. Endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA) is the standard method for obtaining samples from pancreatic masses. In recent years, there has been an increasing need to obtain histological specimens during EUS procedures, rather than cytological ones, to guide oncological treatment options, leading to the so-call “FNB concept.” Different needles have been developed for fine-needle biopsy (FNB) in recent years, enabling acquisition of larger specimens on which to perform histological and molecular analyses. The aim of this narrative review was to assess the role of EUS-guided FNA and FNB in patients with pancreatic masses, and to identify which needle and which acquisition technique should be used to improve tissue acquisition.

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The Role of EUS-Guided FNA and FNB in Autoimmune Pancreatitis

Diagnostics ◽

10.3390/diagnostics11091653 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1653

Author(s):

Nicolò de Pretis ◽

Stefano Francesco Crinò ◽

Luca Frulloni

Keyword(s):

Pancreatic Cancer ◽

Autoimmune Pancreatitis ◽

Fine Needle Biopsy ◽

Needle Aspiration ◽

Tissue Architecture ◽

Fine Needle ◽

Tissue Acquisition ◽

Histological Confirmation

Autoimmune pancreatitis (AIP) is an increasingly recognized disease classified into two different subtypes based on histology. According to the International Diagnostic Criteria (ICDC), the diagnosis is achieved using a combination of different criteria. In patients presenting with a typical imaging appearance, the diagnosis may be straightforward, and steroid treatment is recommended, even without histological confirmation. In patients with atypical imaging or mass-forming appearance, the differential diagnosis with pancreatic cancer is challenging and crucial for treatment strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition has been proposed to achieve a histological diagnosis. Fine-needle aspiration (FNA) was first proposed to aspirate cells from pancreatic lesions. Despite excellent results in terms of sensitivity for pancreatic cancer, the data are disappointing regarding the diagnosis of AIP. The recent development of new needles allowing fine-needle biopsy (FNB) has been associated with improved diagnostic accuracy based on preserving the tissue architecture, which is necessary to detect the typical histological features of AIP. However, the published literature on the role of EUS-guided FNA and FNB is limited and mainly focused on type 1 AIP. The present study aimed to review the available literature on the role of EUS-guided FNA and FNB in the diagnosis of AIP.

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Diagnostic accuracy of endoscopic-ultrasound-guided fine-needle aspiration in the study of pancreatic masses with and without rapid-on-site-evaluation. The role of the experience

Pancreatology ◽

10.1016/j.pan.2015.05.319 ◽

2015 ◽

Vol 15 (3) ◽

pp. S87

Author(s):

Noé Quesada Vázquez ◽

José Ramón Aparicio Tormo

Keyword(s):

Diagnostic Accuracy ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle ◽

Pancreatic Masses ◽

Site Evaluation

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IS THE NEW PROCORE 20G DOUBLE FORWARD-BEVEL NEEDLE CAPABLE TO OBTAIN BETTER HISTOLOGICAL SAMPLES BY ENDOSCOPIC ULTRASOUND FOR DIAGNOSING SOLID PANCREATIC LESIONS?

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020200004e1554 ◽

2020 ◽

Vol 33 (4) ◽

Author(s):

José Celso ARDENGH ◽

Vitor Ottoboni BRUNALDI ◽

Mariângela Ottoboni BRUNALDI ◽

Alberto Facuri GASPAR ◽

Jorge Resende LOPES-JÚNIOR ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Biopsy ◽

Needle Aspiration ◽

Technical Success ◽

Tissue Samples ◽

Fine Needle ◽

Biopsy Methods ◽

Sensitivity Specificity ◽

Adequate Tissue

ABSTRACT Background: It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. Aim: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. Methods: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. Results: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. Conclusions: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.

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The Feasibility and Histological Diagnostic Accuracy of Novel Menghini Needle (EUS Sonopsy CY™) for Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy of Solid Pancreatic Masses: A Prospective Crossover Study Comparing Standard Biopsy Needles

Gastroenterology Research and Practice ◽

10.1155/2019/5810653 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Ryo Igarashi ◽

Atsushi Irisawa ◽

Manoop S. Bhutani ◽

Irina M. Cazacu ◽

Goro Shibukawa ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Crossover Study ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Fine Needle ◽

Pancreatic Masses ◽

Tissue Acquisition ◽

Needle Aspiration Biopsy

Background and Objectives. Recently, a 21G Menghini-type needle for EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been developed. The stylet of the EUS Sonopsy CY™ remains inside the needle during aspiration. Therefore, it is expected to obtain higher-quality histological core specimens without crushing the material or blood contamination. The aim of this study is to evaluate the feasibility and diagnostic accuracy of EUS-FNAB of solid pancreatic masses with this new biopsy needle. Methods. A total of 30 patients with solid pancreatic masses who underwent EUS-FNAB with two different types of needles, EUS Sonopsy™ and ProCore™, were included in a prospective, randomized, controlled, crossover study. All the pancreatic masses were punctured with the two needles and were randomized regarding the order of the needle to be used. The primary outcome was to compare the diagnostic accuracy and the rates of tissue acquisition of the two needles. Results. The tissue acquisition rate was not significantly different between the EUS Sonopsy CY™ needle and the ProCore™ needle (78.6% vs. 82.1%, P=1.00). The histological diagnostic accuracy was also similar between the two needles (73% vs. 80%, P=.63). There was also no difference regarding the accuracy of cytology alone and the combination of both histological and cytological assessments between the EUS Sonopsy CY™ needle and the ProCore™ needle (90% vs. 87%, P=1.00 and 90% vs. 90%, P=1.00, respectively). Conclusions. EUS Sonopsy CY™ is a reliable device for EUS-FNAB of solid pancreatic masses.

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Evaluation of Role of Ultra Sound Guided Fine Needle Aspiration Cytology for Diagnosis of Ovarian Lesions with Particular References to Diagnostic Pitfalls

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v13i2.14520 ◽

2014 ◽

Vol 13 (2) ◽

pp. 158-162

Author(s):

Sanjay Sengupta ◽

Rajib Kumar Mondal ◽

Kingshuk Bose ◽

Rudranarayan Ray ◽

Sritanu Jana ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Medical Science ◽

Needle Aspiration ◽

Ultra Sound ◽

Histopathological Diagnosis ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Background: Ovarian lesions are quite common among females of all age groups. Ovarian cancers account for 6% of female malignancy. Ultrasonography (USG) can help in proper identification and categorization of these lesions. Fine Needle Aspiration Cytology (FNAC) under USG guidance can be an effective modality for early diagnosis of ovarian masses. Aims And Objectives: To evaluate the role of USG guided FNAC over ovarian space occupying lesions (SOLs) for proper categorization into non-neoplastic, benign & malignant variants and to identify possible underlying causes of cytological misdiagnosis, if any, in comparison to histopathological diagnosis. Materials and Methods: FNAC under USG guidance were performed over one hundred and sixteen cases with radiologically proved ovarian SOLs during a period of five years. Aspirated materials were interpreted as non- neoplastic, benign or malignant lesions. Histopathological study was possible in 47 of these cases. Results: Out of 116 aspirations, non-neoplastic, benign and malignant diagnosis were given in 51, 42 & 23 cases, respectively. During histopathological correlation 41 out of 47 cases (87.2%) show exact cytohistological parity. Rest six cases with cytological misdiagnosis were discussed in detail. Conclusion: USG guided FNAC can effectively diagnose ovarian lesions in more than 87% cases. Scrutiny about failed diagnosis will help to improve accuracy in future. DOI: http://dx.doi.org/10.3329/bjms.v13i2.14520 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.158-162

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