The accuracy and clinical impact of endoscopic ultrasound-guided dual needle sampling in solid pancreatic lesions

BACKGROUND AND OBJECTIVES: Different tissue entities can present as solid pancreatic lesions (SPLs). This study aimed to explore the diagnostic accuracy of endoscopic ultrasound-guided dual needle sampling (endoscopic ultrasound-guided fine needle aspiration/biopsy [EUS-FNA/B]) in SPLs. METHODS: In 2012-2016, consecutive patients with SPLs were prospectively included in a single-center setting aiming at dual sampling with EUS-FNA (22/25-gauge) and reverse bevel EUS-FNB (22-gauge) in each lesion. Randomization decided if the first pass should be EUS-FNA or EUS-FNB. The primary outcome was the diagnostic accuracy including mandatory immunostaining of all tumors but pancreatic ductal adenocarcinoma (PDAC). The secondary outcome was the clinical impact of dual needle sampling EUS-FNA/B in comparison with single needle EUS-FNA of SPLs performed in the same center 2006-2011 (the comparison cohort). RESULTS: In 108 study subjects, 68 dual needle sampling procedures were performed. The four most common entities were PDAC (32%), neuroendocrine tumor (34%), pancreatitis (15%), and metastasis (6%). EUS-FNA and EUS-FNB had comparable diagnostic accuracy. EUS-FNA/B, compared with EUS-FNA, had a higher sensitivity for malignancy (91% vs. 75%, P = 0.004), higher sensitivity for non-PDAC malignancy (89% vs. 69%, P=0.02), and higher overall accuracy (91% vs. 78%, P=0.004). The performance of an additional diagnostic procedure was less frequent after EUS-FNA/B compared with EUS-FNA of the comparison cohort (4% vs. 21%, P=0.007). CONCLUSIONS: Reverse bevel EUS-FNB is not superior to EUS-FNA in the sampling of solid pancreatic lesions. However, dual needle sampling with both modalities (EUS-FNA/B) seems to improve the diagnostic accuracy and facilitate the clinical management, especially in malignant entities other than ductal adenocarcinomas.