Impact of Macroscopic On-Site Evaluation on Endoscopic Ultrasound-Guided fine Needle Biopsy of Pancreatic and Extrapancreatic Solid Lesions

Aims Macroscopic on-site evaluation (MOSE) looks promising for estimating the adequacy of EUS-FNB samples, in order to reduce the number of passes needed to achieve a diagnosis.

Methods This is a prospective and comparative study including all consecutive EUS-FNB of pancreatic and extrapancreatic solid lesions between December 2019-September 2020. Based on the technique (MOSE or conventional) we identified two consecutive groups, MOSE and Control. 22-25 G Acquire needles were used with a standard of 3 passes. MOSE samples were differentiated into 4 inspective levels (0-1-2-3), on the basis of the quality-quantity. Primary outcomes were: degree of adequacy and accuracy of the material at each single pass; concordance between macroscopic observation of the frustule and the pathologist’s judgment of adequacy. Secondary outcomes included sensitivity, specificity, PPV, NPV and complication rate.

Results 76 patients were included for histological analysis (38 MOSE, 38 Control). Overall, diagnosis was obtained at the first pass in 63 % (48/76) of the patients, at the second in 17.1 % (13/76), at the third in 7.9 % (3/76). No diagnostic sample was obtained in 15.8 % (12/76). There was no statistically significant difference in the diagnostic adequacy of the two groups (MOSE 97.4 % vs Controls 91.7 %, p = 0.06) and in diagnostic accuracy (MOSE 86.8 % vs Controls 81.8 %, p = 0.76). Overall 97.4 % (112/115) of the passes had a concordance between the MOSE judgment and anatomo-pathological adequacy. Overall, the EUS-FNB had a sensitivity of 90.6 %, specificity of 100 %, VPP of 100 % and NPV of 60 %. Complication rate was 3.8 % (2 bleeding and 1 acute edematous pancreatitis).

Conclusions Diagnostic yield was comparable in both techniques, but MOSE allows endoscopists to perform an inspective evaluation of the material and a limitation of the number of passes to a minimum of one or two, with a high level of confidence, reducing procedural times and risk of complications.

Citation: Rizza S, Gaia S, Bruno M et al. OP70 IMPACT OF MACROSCOPIC ON-SITE EVALUATION ON ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE BIOPSY OF PANCREATIC AND EXTRAPANCREATIC SOLID LESIONS. Endoscopy 2021; 53: S29.

Publication History

Article published online:
19 March 2021