OUTCOMES OF ENDOSCOPIC ULTRASOUND (EUS)-GUIDED MICROFORCEPS BIOPSY OF PANCREATIC CYST LESIONS-A SINGLE CENTER EXPERIENCE

Aims: Background EUS-guided microforceps biopsy (MFB) targeting wall of pancreatic cyst or a mural nodule can increase diagnostic yield of pancreatic cystic lesions (PCLs) and provides an adjunctive tool to FNA in an attempt to increase diagnostic accuracy.

Aim To assess the feasibility, diagnostic yield and complications of EUS-guided MFB performed on PCLs in a single tertiary care centre.

Methods We collected retrospective data from January 2018 to October 2019 for all patients undergone EUS FNA and MFB for PCLs identified on cross-sectional imaging. We compared FNA and MFB results with CEA levels and surgical specimens of patients who had surgical resection.

Results Total of 36 EUS-FNA and MFB of PCLs were performed in 33 patients. 31 PCLS were found in body and tail of pancreas and 5 PCLs were in head and neck. MFB was technically successful in all cases. Twenty two samples were deemed adequate for histological diagnosis (yield 61%).

Out of 31 patients, 12 had CEA level higher than 192 microgram/Litre (mean=5405.5).

PCL type diagnosed on the tissue taken with MFB was mucinous cyst lesions in 13 (36%) patients, serous cyst adenomas in 3 (8.3%), pseudocysts in 3 (8.3%), lymphoproliferative cysts in 3 (8.3%) and was non-diagnostic due to inadequate sample in 14 (38.8%).

MFB ascertained diagnosis in 7 (19.4%) of those patients whose FNAs were non-diagnostic. On the other hand, FNA was diagnostic in 3 (8.3%) patients whose MFB was inconclusive due to inadequate samples.

Six of our patients underwent pancreatic surgery and resection histology matched MFB results in 5 of them.

There were no procedure-related major complications.

Conclusions EUS with microforceps biopsy sampling is technically feasible and safe procedure and could be a useful adjunct to EUS FNA. Further studies will be required to establish diagnostic accuracy and sensitivity of the method.