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Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

BACKGROUND: Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps in PCLs has been made available. AIM: To assess the efficacy and safety of EUS-TTNB in the...

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Autores principales: Hashimoto, Rintaro, Lee, John G, Chang, Kenneth J, Chehade, Nabil El Hage, Samarasena, Jason B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875688/
https://www.ncbi.nlm.nih.gov/pubmed/31798774
http://dx.doi.org/10.4253/wjge.v11.i11.531
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author Hashimoto, Rintaro
Lee, John G
Chang, Kenneth J
Chehade, Nabil El Hage
Samarasena, Jason B
author_facet Hashimoto, Rintaro
Lee, John G
Chang, Kenneth J
Chehade, Nabil El Hage
Samarasena, Jason B
author_sort Hashimoto, Rintaro
collection PubMed
description BACKGROUND: Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps in PCLs has been made available. AIM: To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs. METHODS: We retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration (FNA) for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis. RESULTS: A total of 56 patients (mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8 mm (12-85 mm). The EUS-TTNB procedure was technically successful in all patients (100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA, respectively 80.4% (45/56) vs 25% (14/56). Adverse events occurred in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Using TTNB specimens, 23 of 32 cases (71.9%) with intraductal papillary mucinous neoplasm were further differentiated into gastric type (19 patients) and pancreaticobiliary type (4 patients) based on immunochemical staining. CONCLUSION: EUS-TTNB for PCLs was technically feasible and had a favorable safety profile. Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen. EUS-TTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.
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spelling pubmed-68756882019-12-03 Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience Hashimoto, Rintaro Lee, John G Chang, Kenneth J Chehade, Nabil El Hage Samarasena, Jason B World J Gastrointest Endosc Observational Study BACKGROUND: Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps in PCLs has been made available. AIM: To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs. METHODS: We retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration (FNA) for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis. RESULTS: A total of 56 patients (mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8 mm (12-85 mm). The EUS-TTNB procedure was technically successful in all patients (100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA, respectively 80.4% (45/56) vs 25% (14/56). Adverse events occurred in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Using TTNB specimens, 23 of 32 cases (71.9%) with intraductal papillary mucinous neoplasm were further differentiated into gastric type (19 patients) and pancreaticobiliary type (4 patients) based on immunochemical staining. CONCLUSION: EUS-TTNB for PCLs was technically feasible and had a favorable safety profile. Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen. EUS-TTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs. Baishideng Publishing Group Inc 2019-11-16 2019-11-16 /pmc/articles/PMC6875688/ /pubmed/31798774 http://dx.doi.org/10.4253/wjge.v11.i11.531 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Observational Study
Hashimoto, Rintaro
Lee, John G
Chang, Kenneth J
Chehade, Nabil El Hage
Samarasena, Jason B
Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
title Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
title_full Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
title_fullStr Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
title_full_unstemmed Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
title_short Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
title_sort endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: a large single center experience
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875688/
https://www.ncbi.nlm.nih.gov/pubmed/31798774
http://dx.doi.org/10.4253/wjge.v11.i11.531
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