Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors

Leonardo H. Eusebi; Douglas Thorburn; Christos Toumpanakis; Leonardo Frazzoni; Gavin Johnson; Sheida Vessal; Tu Vinh Luong; Martyn Caplin; Stephen P. Pereira

doi:10.1055/a-0967-4684

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1393-E1399
DOI: 10.1055/a-0967-4684

Original article

Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors

Authors

Leonardo H. Eusebi

¹HPB endoscopy unit, Royal Free Hospital NHS Trust, London, UK

²Department of Medical and Surgical Sciences, University of Bologna, Italy
Douglas Thorburn

¹HPB endoscopy unit, Royal Free Hospital NHS Trust, London, UK
Christos Toumpanakis

³Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital NHS Trust, London, UK
Leonardo Frazzoni

²Department of Medical and Surgical Sciences, University of Bologna, Italy
Gavin Johnson

¹HPB endoscopy unit, Royal Free Hospital NHS Trust, London, UK

⁴Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
Sheida Vessal

¹HPB endoscopy unit, Royal Free Hospital NHS Trust, London, UK
Tu Vinh Luong

⁵Department of Cellular Pathology, Royal Free London NHS Foundation, London, UK
Martyn Caplin

³Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital NHS Trust, London, UK
Stephen P. Pereira

⁴Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK

⁶Institute for Liver & Digestive Health, University College London, UK

Abstract

Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as a method of obtaining preoperative diagnosis of pancreatic neuroendocrine tumors (PanNETs) has been reported in several series. Fine-needle biopsies (FNB) are increasingly employed to obtain core specimens during EUS. However, the differences in efficacy between these sampling methods in the diagnosis of PanNETs still needs to be defined.

Patients and methods Over a 13-year period, all patients who underwent EUS-guided tissue sampling of suspicious pancreatic lesions with clinical, endoscopic and pathologic details were entered into an electronic database. Lesions underwent EUS-FNA or FNB sampling, or a combination of the two. The accuracy and safety of different EUS-guided sampling methods for confirmed PanNETs were investigated.

Results A total of 91 patients (M/F: 42/49, median age: 57 years), who underwent 102 EUS procedures had a final diagnosis of PanNET. Both EUS-guided sampling modalities were used in 28 procedures, EUS-FNA alone was used in 61 cases, while EUS-FNB alone in 13 cases. Diagnostic yield of EUS-FNA and EUS-FNB alone, including the inadequate specimens, was 77.5 % (95 %CI: 68.9 – 86.2 %) and 85.4 % (95 %CI: 74.6 – 96.2 %), respectively. The combination of both sampling modalities established the diagnosis in 96.4 % of cases (27/28) (95 %CI: 89.6 – 100 %), significantly superior to EUS-FNA alone (P = 0.023). Diagnostic sensitivity among the adequate samples for EUS-FNA, EUS-FNB and for the combination of the two methods was 88.4 % (95 %CI: 80.9 – 96.0 %), 94.3 % (95 %CI: 86.6 – 100 %) and 100 % (95 %CI: 100 – 100 %). There was one reported complication, a post-FNA bleeding, treated conservatively.

Conclusions EUS-FNB improves diagnostic sensitivity and confers additional information to cytological assessment of PanNETs.

Full Text

References

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