EUS-guided reverse bevel fine-needle biopsy sampling and open tip fine-needle aspiration in solid pancreatic lesions – a prospective, comparative study

Abstract

Objectives: Different diagnostic entities can present as solid pancreatic lesions (SPL). This study aimed to explore the utility of endoscopic ultrasound-guided reverse bevel fine-needle biopsy sampling (EUS-FNB) in SPLs.

Material and methods: In 2012–2015, consecutive patients with SPLs were prospectively included in a tertiary center setting and subjected to dual needle sampling with a 22 gauge reverse bevel biopsy needle and a conventional 25 gauge open tip aspiration needle (EUS-FNA). The outcome measures were the diagnostic accuracy of sampling, calculated for each modality separately and for the modalities combined (EUS-FNA + FNB), and the adverse event rate related to sampling.

Results: In 68 unique study subjects, the most common diagnostic entities were pancreatic neuroendocrine tumor, PNET, (34%), pancreatic ductal adenocarcinoma, PDAC, (32%), pancreatitis (15%) and metastasis (6%). The overall diagnostic accuracy of EUS-FNB was not significantly different from that of EUS-FNA, (69% vs. 78%, p = .31). EUS-FNA + FNB, compared with EUS-FNA alone, had a higher sensitivity for tumors other than PDAC (89% vs. 69%, p = .02) but not for PDACs (95% vs. 85%, p = .5). No adverse event was recorded after the study dual-needle sampling procedures.

Conclusions: Endoscopic ultrasound-guided tissue acquisition performed with a 22 gauge reverse bevel biopsy needle is safe but not superior to conventional fine-needle aspiration performed with a 25 gauge open tip needle in diagnosing solid pancreatic lesions. However, the performance of both these modalities may facilitate the diagnostic work-up in selected patients, such as cases suspicious for pancreatic neuroendocrine tumors and metastases. NCT02360839.

Keywords:

• Endoscopic ultrasonography
• endoscopic ultrasound-guided fine needle aspiration
• fine needle biopsy
• neuroendocrine tumors
• pancreatic neoplasms
• equipment safety
• risk management

Acknowledgements

The authors would like to thank all staff at:

the GEA endoscopy unit, Sahlgrenska University Hospital, Margareta Netsner, Department of Clinical Pathology, Sahlgrenska University Hospital, for practical assistance.

Dr Sven-Petter Haugvik, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Norway; Dr Alastair Hayes, Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, Scotland; Professor Hanns-Ulrich Marschall, Sahlgrenska University Hospital; and Associate Professor Björn Lindkvist, Sahlgrenska University Hospital, for constructive comments upon the manuscript.

Institutional review board statement

This study was reviewed and approved by the Regional Ethical Review Board of Gothenburg (Study code: Dnr 573-09/Dnr 1092-11).

Written informed consent was obtained from all individual participants included in the study.

Disclosure statement

Per Hedenström, Akif Demir, Kaveh Khodakaram, and Ola Nilsson declare no conflicts of interest for this article. Riadh Sadik would like to report honoraria for lectures from Ferring, Abbvie, Olympus, COOK medical, and Boston Scientific unrelated to this project and outside the submitted work.

Additional information

Funding

This work was not supported by any commercials interests. This work was supported by The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, under Grant number VGFOUREG-564381 and VGFOUREG-144591; The Sahlgrenska University Hospital LUA-ALF under Grant number 73830; and The Swedish Society of Medicine under Grant number SLS-404261, SLS-325061.