Endoscopic ultrasound-guided tissue acquisition with or without rapid on-site evaluation for solid pancreatic lesions: five years of experience from a single center

Abstract

Background

Endoscopic ultrasound (EUS)-guided tissue acquisition (TA) by EUS-guided fine needle aspiration (FNA) or fine needle biopsy (FNB) is a standard diagnostic procedure for solid pancreatic lesions. Whether rapid on-site evaluation (ROSE) should be used to support EUS-TA remains controversial. Here we assessed the diagnostic performance of EUS-TA with or without self-ROSE for solid pancreatic masses.

Methods

Three hundred and seventy EUS-TA cases with self-ROSE and 244 cases without ROSE were retrospectively enrolled between August 2018 and June 2022. All procedures including ROSE were performed by the attending endoscopist. Clinical data, EUS characteristics, and diagnostic performance for distinguishing benign from malignant solid pancreatic masses including accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared between groups.

Results

Self-ROSE improved the diagnostic accuracy of solid pancreatic lesions by 16.7% in the EUS-TA group (p < 0.001) and by 18.9% in the EUS-FNA alone group (p < 0.001). Self-ROSE also improved the diagnostic sensitivity by 18.6% in the EUS-TA group (p < 0.001) and by 21.2% in the EUS-FNA alone group (p < 0.001). Improvements in the diagnostic accuracy by self-ROSE in the EUS-FNB group were not significant. 2.2 ± 0.7, 2.4 ± 0.9, 2.3 ± 0.7, 2.5 ± 0.9, 2.1 ± 0.6, and 2.1 ± 0.7 needle passes were required in the EUS-TA, EUS-FNA, and EUS-FNB with or without self-ROSE groups, respectively.

Conclusions

Self-ROSE significantly improved the accuracy and sensitivity of EUS-FNA alone and EUS-TA diagnosis of solid pancreatic lesions and helped to reduce needle passes during the procedure. Whether self-ROSE benefits EUS-FNB and whether EUS-FNB alone is comparable to EUS-FNA with self-ROSE require further clarification.

Keywords:

• Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)
• endoscopic ultrasound-guided fine needle biopsy (EUS-FNB)
• endoscopic ultrasound-guided tissue acquisition (EUS-TA)
• self-rapid on-site evaluation (self-ROSE)
• diagnostic efficacy

Acknowledgements

We would like to thank our colleagues in the medical and nursing teams of the Gastroenterology Department. We would also like to thank Professor Haiyu Pang and Kai Sun for their patient help and guidance in the statistical analyses.

Disclosure statement

All authors have completed the ICMJE uniform disclosure form. Dr. Yongru Liu, Dingkun Xiong, Yu Zhao, Zhilan Meng, Xi Wu, Qingwei Jiang, Qiang Wang, Dongsheng Wu, Shengyu Zhang, Yunlu Feng and Aiming Yang have no conflicts of interest or financial ties to disclose.

Data availability statement

Full data and study protocol can be obtained by contacting with the correspondence authors.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the National Key Clinical Specialist Construction Project [ZK108000], National High-Level Hospital Clinical Research Funding [2022-PUMCH-B-024, 2022-PUMCH-A-177], National Natural Science Foundation of China, Joint Fund Project [Integrated Project Grant No. U20A6001], and CAMS Innovation Fund for Medical Sciences [CIFMS, 2022-I2M-C&amp;T-B-012].