Through-the-needle biopsy of pancreatic cystic lesions: current evidence and implications for clinical practice

ABSTRACT

Introduction

There is increasing evidence to support the efficacy of endoscopic ultrasound (EUS)-guided through-the-needle biopsy (TTNB) technique as a means of sampling pancreatic cystic lesions (PCLs). Results provide evidence demonstrating the benefits of this procedure over standard EUS fine-needle aspiration (FNA), thus supporting a push for its widespread implementation in clinical practice. Though this technique has demonstrated advantages, achieving these advantages in clinical practice is contingent upon careful considerations to ensure safety and efficacy.

Areas covered

The purpose of this review is to assess the level of evidence supporting the use of through-the-needle biopsy, revise its main technical and procedural characteristics, and to develop suggested guidelines outlining the safe assimilation of this device in clinical practice.

Expert opinion

EUS-TTNB enables more definitive and accurate diagnosis of PCLs by providing higher-quality histological samples. However, EUS-TTNB is not appropriate for all PCLs. Selection of suitable patients as well as morphology and risk factors of the cystic lesion is a crucial component of achieving the described benefits of this procedure while minimizing risks of adverse effects. Subjects with weak or absent indications for this procedure are susceptible to a range of complications and may even result in fatality.

KEYWORDS:

• TTNB
• pancreas
• tumor
• mucinous
• EUS

Article highlights

• Endoscopic ultrasound (EUS) plays a fundamental role in differentiation of pancreatic cystic lesions.

• Through-the-needle microforceps device (Moray Microforceps®, US Endoscopy, Mentor, OH, USA) was recently created to carry out EUS-guided biopsy sampling of pancreatic cystic lesions (PCLs).

• EUS through-the-needle microforceps biopsy can accurately diagnose PCLs with a higher degree of precision, particularly when the morphology of the cyst is nonspecific.

• Improper patient selection contributes to high adverse events as well as lower percentage of disease detection.

• EUS-TTNB should be considered in cases where a definitive diagnosis of PCL will direct crucial patient management.

Declaration of Interest

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.