Diagnosis of pancreatic solid lesions by ultrasound endoscopy fine-needle biopsy with Franseen needles: macroscopic on-site (MOSE) versus rapid on-site (ROSE) evaluation. Is the pathologist necessary in the endoscopy suite?

Aims The evaluation of biopsy samples obtained with fine-needle biopsy (FNB-EUS) using Franseen needles by ultrasound endoscopy by endoscopist (Macroscopic On-Site Evaluation: MOSE) improves the diagnostic accuracy of pancreatic solid lesions. The achievement of macroscopic visible core (MVC)>4mm has a high diagnostic accuracy with MOSE.

Aim: To compare diagnostic accuracy of Rapid On-Site Evaluation (ROSE) and MOSE by endoscopist in pancreatic solid lesions.

Methods Prospective bicentric study, consecutive recruitment of patients with pancreatic solid lesions in 2 general hospitals (MOSE was performed in hospital A and ROSE in hospital B). Franseen needles were used (Adquire, Boston Scientific). We evaluated: 1) diagnostic achievement and accuracy (including sensitivity, specificity, positive predictive value and negative predictive value) in solid pancreatic lesions; 2) MVC>4mm acquisition; and 3) number of needle passes needed with MOSE vs ROSE.

Results A total of 132 patients were included (33 women, 68 men, median age 68,2±1,025). MOSE was performed in 90 (68.2%) and ROSE in 42 (31.8%); in 110 (83.3%) malign and 22 (16.7%) benign pancreatic solid lesions. Correct diagnosis by EUS-FNB was achieved in 89.4% patients (with MOSE 88.8%; and ROSE 92.9%; p=0.54). Sensitivity was 100%, specificity 89%, PPV 81.3% and NPV 100% (with MOSE: sensitivity 100%, specificity 87.5%, PPV 88.8% and NPV 100%; with ROSE: sensitivity 100%, specificity 92.1%, PPV 92.6% and NPV 100%). MVC>4mm was obtained in 72.7% (71.1% in MOSE, 76.2% in ROSE, p=0.67). There were no statistically significant differences in diagnosis achievement between MVC>4mm and<4mm (88.6% in MOSE and 90.6% in ROSE, p=0.74). No differences in number of passes necessary to achieve diagnosis was found between MOSE and ROSE.

Conclusions Evaluation of biopsy simples of pancreatic solid lesions obtained by FNB-EUS with Franseen needles by endoscopist (MOSE) has a diagnostic accuracy similar to ROSE, making unnecessary the presence of a pathologist in the endoscopy suite.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024