Factors Influencing the Diagnostic Performance of Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy after the First Inconclusive Diagnosis of Pancreatic Solid Lesions
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Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is essential in diagnosing solid pancreatic lesions (SPLs), but without rapid on-site evaluation (ROSE), a repeat EUS-FNA/B is crucial for clarifying an inconclusive diagnosis. We aimed to evaluate factors associated with improved diagnostic performance of repeat EUS-FNA/B for initially inconclusive SPL diagnoses without ROSE. Methods: Of 5,894 patients subjected to EUS-FNA/B, 237 (4.0%) with an initially inconclusive diagnosis of SPLs were retrospectively enrolled from five tertiary medical centers between January 2016 and June 2021. Diagnostic performance and procedural factors of EUS-FNA/B were analyzed. Results: The diagnostic accuracies of first and repeat EUS-FNA/B were 96.2% and 67.6%, respectively. Of 237 patients with an inconclusive diagnosis from initial EUS-FNA/B, 150 were pathologically diagnosed after repeat EUS-FNA/B. In multivariate analysis of repeat EUS-FNA/B, tumor location (body/tail vs head: odds ratio [OR], 3.74; 95% confidence interval [CI], 1.48 to 9.46), number of needle passes (≥4 vs ≤3: OR, 4.80; 95% CI, 1.44 to 15.99), needle type (FNB vs FNA: OR, 3.26; 95% CI, 1.44 to 7.36), needle size (22 gauge vs 19/20 gauge: OR, 2.35; 95% CI, 1.19 to 4.62), and suction method (suction vs others: OR, 5.19; 95% CI, 1.30 to 20.75) were associated with a significantly improved diagnostic performance. Conclusions: Repeat EUS-FNA/B is essential for patients with an inconclusive EUS-FNA/B without ROSE. To improve the diagnostic performance of repeated EUS-FNA/B, it is recommended that 22-gauge FNB needles, ≥4 needle passes, and suction methods are used.
Abstract
Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is essential in diagnosing solid pancreatic lesions (SPLs), but without rapid on-site evaluation (ROSE), a repeat EUS-FNA/B is crucial for clarifying an inconclusive diagnosis. We aimed to evaluate factors associated with improved diagnostic performance of repeat EUS-FNA/B for initially inconclusive SPL diagnoses without ROSE. Methods: Of 5,894 patients subjected to EUS-FNA/B, 237 (4.0%) with an initially inconclusive diagnosis of SPLs were retrospectively enrolled from five tertiary medical centers between January 2016 and June 2021. Diagnostic performance and procedural factors of EUS-FNA/B were analyzed. Results: The diagnostic accuracies of first and repeat EUS-FNA/B were 96.2% and 67.6%, respectively. Of 237 patients with an inconclusive diagnosis from initial EUS-FNA/B, 150 were pathologically diagnosed after repeat EUS-FNA/B. In multivariate analysis of repeat EUS-FNA/B, tumor location (body/tail vs head: odds ratio [OR], 3.74; 95% confidence interval [CI], 1.48 to 9.46), number of needle passes (≥4 vs ≤3: OR, 4.80; 95% CI, 1.44 to 15.99), needle type (FNB vs FNA: OR, 3.26; 95% CI, 1.44 to 7.36), needle size (22 gauge vs 19/20 gauge: OR, 2.35; 95% CI, 1.19 to 4.62), and suction method (suction vs others: OR, 5.19; 95% CI, 1.30 to 20.75) were associated with a significantly improved diagnostic performance. Conclusions: Repeat EUS-FNA/B is essential for patients with an inconclusive EUS-FNA/B without ROSE. To improve the diagnostic performance of repeated EUS-FNA/B, it is recommended that 22-gauge FNB needles, ≥4 needle passes, and suction methods are used.
참고문헌 (22)
- Park JH, "BRCA 1", 2 germline mutation predicts the treatment response of FOLFIRINOX with pancreatic ductal adenocarcinoma in Korean patients, 2022, pp.14, 236~
- Choi JI, "The role of Jagged1 as a dynamic switch of cancer cell plasticity in PDAC assembloids", Theranostics, 12, pp.4431~4445 (2022)
- Cho IR, "Diagnostic performance of endoscopic ultrasound elastography for differential diagnosis of solid pancreatic lesions : a propensity score-matched analysis", Pancreatology, 23, pp.105~111 (2023)
- Polkowski M, "Technical aspects of endoscopic ultrasound(EUS)-guided sampling in gastroenterology : European Society of Gastrointestinal Endoscopy(ESGE)Technical Guideline. March 2017", Endoscopy, 49, pp.989~1006 (2017)
- Cho IR, "Comparison of contrast-enhanced versus conventional EUSguided FNA", fine-needle biopsy in diagnosis of solid pancreatic lesions : a randomized controlled trial, 2021, pp.94, 303~310
- Sun B, "Impact of inconclusive endoscopic ultrasound-guided fine-needle aspiration results in the management and outcome of patients with solid pancreatic masses", Dig Endosc, 27, pp.130~136 (2015)
- Suzuki R, "Repeat endoscopic ultrasound-guided fine needle aspiration for solid pancreatic lesions at a tertiary referral center will alter the initial inconclusive result", J Gastrointestin Liver Dis, 22, pp.183~187 (2013)
- Chung MJ, "Clinical and technical guideline for endoscopic ultrasound(EUS)-guided tissue acquisition of pancreatic solid tumor : Korean Society of Gastrointestinal Endoscopy(KSGE)", Gut Liver, 15, pp.354~374 (2021)
- van Riet PA, "Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions : a systemic review and meta-analysis", Endoscopy, 53, pp.411~423 (2021)
- DeWitt J, "Utility of a repeated EUS at a tertiary-referral center", Gastrointest Endosc, 67, pp.610~619 (2008)
- Lisotti A, "Repeat EUS-FNA of pancreatic masses after nondiagnostic or inconclusive results : systematic review and meta-analysis", Gastrointest Endosc, 91, pp.1234~1241 (2020)
- Mitchell RA, "Repeat endoscopic ultrasound-guided fine-needle aspiration in patients with suspected pancreatic cancer : diagnostic yield and associated change in access to appropriate care", Can J Gastroenterol Hepatol, 2016, pp.7678403~ (2016)
- Téllez-Ávila FI, "Repeat endoscopic ultrasound fine needle aspiration after a first negative procedure is useful in pancreatic lesions", Endosc Ultrasound, 5, pp.258~262 (2016)
- Jeong SH, "High-resolution endoscopic ultrasound imaging and the number of needle passages are significant factors predicting high yield of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses without an on-site cytopathologist", Medicine(Baltimore), 96, pp.e5782~ (2017)
- Stathopoulos P, "Endoscopic ultrasound-fine needle biopsies of pancreatic lesions : prospective study of histology quality using Franseen needle", World J Gastroenterol, 26, pp.5693~5704 (2020)
- Karsenti D, "22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses : a randomized study comparing histologic sample quantity and diagnostic accuracy", Endoscopy, 52, pp.747~753 (2020)
- Oh D, "A comparison between 25-gauge and 22-gauge Franseen needles for endoscopic ultrasoundguided sampling of pancreatic and peripancreatic masses : a randomized non-inferiority study", Endoscopy, 53, pp.1122~1129 (2021)
- Ku L, "Improved diagnostic yield of endoscopic ultrasound-fine needle biopsy with histology specimen processing", World J Gastrointest Endosc, 12, pp.212~219 (2020)
- Paik WH, "Malignant potential of small pancreatic neuroendocrine neoplasm and its risk factors : a multicenter nationwide study", Pancreatology, 21, pp.208~214 (2021)
- Li SY, "Diagnostic efficacy of three suction techniques for endoscopic ultrasound-guided fineneedle biopsy of solid pancreatic lesions : protocol for a multicenter randomized cross-over clinical trial", Dig Liver Dis, 52, pp.734~739 (2020)
- Young Bang J, "Comparing needles and methods of endoscopic ultrasound-guided fine-needle biopsy to optimize specimen quality and diagnostic accuracy for patients with pancreatic masses in a randomized trial", Clin Gastroenterol Hepatol, 19, pp.825~835 (2021)
- Crinò SF, "Endoscopic ultrasound-guided fine-needle biopsy with or without rapid onsite evaluation for diagnosis of solid pancreatic lesions : a randomized controlled non-inferiority trial", Gastroenterology, 161, pp.899~909 (2021)