EUS FNB HAS SUPERIOR ACCURACY TO EUS FNA IN THE DIAGNOSTIC OF HEPATIC MASSES

Aims To show higher accuracy and immunohistochemistry availability of the Acquire-FNB needle versus the standard FNA needle

Methods The patient’s database was collected prospectively from January 2018 to November 2019. We included patients aged between 18-80 years, with hepatic solid masses of unknown etiology, discovered by conventional imaging, where percutaneous biopsy was limited by ascites or the location of the mass.

We used a linear ultrasound endoscope with a working channel (GF-UCT180-AL5, Olympus) attached to an ultrasound machine (Aloka F75). Ultrasound guided tissue sampling was done with the 22G-FNB (Acquire, Boston Scientific) and standard 22G-FNA (Olympus), in randomized order. We used 1 pass, dry suction, without needle preparation.

Final diagnosis was provided by any positive biopsy or suggestive imaging of the primary lesion in case of negative biopsies. Patients database recorded the final histology diagnosis of each FNA and FNB tissue acquisition, as matched pairs, their compatibility for immunohistochemistry testing, aggregated length and maximum fragment size of histology-core. We calculated the accuracy of each needle. T-Student test was used to compare the aggregated length of histology core.

Results We included 22 patients, mean age of 55.9 years, men:women=2:1. Mean mass size was 19 mm. Etiologies by frequency were: pancreas adenocarcinoma (32%), cholangiocarcinoma (27%), gallbladder carcinoma (18%), hepatocarcinoma (18%), and 1 hepatic abscess. Mean visible/microscopy aggregate histology core was 59±4.6/13.5±4.5 mm for FNB and 48±7.3/6.9±2.8 mm for FNA: t=1.9, p=0.09. FNB accuracy was 100% while FNA was 91%. Immunohistochemistry analysis was possible on 91% of FNB and 55% of FNA. In all patients, percutaneous hepatic biopsy was dismissed because of ascites (36%) or location of the mass near vessels (64%). No post-procedure complications were noted.

Conclusions The Acquire-FNB needle has superior diagnostic accuracy and immunohistochemistry availability than FNA in hepatic masses´ biopsies, without observed complications.