EUS-guided tissue acquisition in patients with solid pseudopapillary neoplasms of the pancreas

ABSTRACT

Objectives

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has been the most common method used for the preoperative cytopathological diagnosis of solid tumors of the pancreas. There are only a few reported cases about the role of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) in the pre-operative diagnosis of solid pseudopapillary neoplasms (SPN). This study aimed to evaluate the diagnostic yield of EUS-TA,including endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) andEUS-FNB, in patients with SPN.

Methods

We performed a retrospective analysis of patients with EUS-TA for SPN diagnosis in 2 referral centers. The primary outcome was the diagnostic yield of EUS-TA compared to the surgical specimen.

Results

Seventy-four patients with SPN of the pancreas were identified. Eighteen had a EUS-TA (10 EUS-FNB and 8 EUS-FNA). The median age of the patients was 31 years (IQR 21–38), and all patients were women. The most common presenting symptom was abdominal pain. Most of the tumors were in the head of the pancreas (9/18; 50%). The median tumor size by EUS was 4.5 cm (min-max 2–15 cm). The most common appearance on EUS was a solid lesion (n = 8/18, 44.4%). A definitive presurgical cytopathological diagnosis was obtained in 16/18 patients (88.8%) with EUS-TA. The sensitivity and positive predictive value of the EUS-TA were 94% each. One patient in the EUS-FNB group developed mild acute pancreatitis.

Conclusion

The diagnostic yield of the EUS-TA in SPN is high. In most cases, the diagnosis was obtained with the first procedure. No differences in the diagnostic yield or AEs between EUS-FNA vs. EUS-FNB needles were seen.

KEYWORDS:

• Solid pseudopapillary neoplasms of the pancreas
• endoscopic ultrasound-guided tissue acquisition
• endoscopic ultrasound-guided fine needle biopsy
• endoscopic ultrasound-guided fine needle aspiration
• solid pancreatic lesions

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. A reviewer on this manuscript has received an honorarium from IPGM for their review work. The reviewers have no other relevant financial relationships or otherwise to disclose.

Author contributions

JGJ study conceptualization, methodology, investigation, data curation, writing original draft, writing review and editing; DLJ supervision, validation, visualization; ALJ supervision, validation, visualization; HGA validation, visualization; SHB investigation, data curation, visualization, VGL investigation, visualization; UDL data curation, supervision, validation, visualization; LRS data curation, validation, visualization; TAF study conceptualization, methodology, investigation, data curation, writing original draft, writing review and editing. All authors read and approved the final manuscript.

Additional information

Funding

This paper was not funded.