Repeated endoscopic ultrasound‐guided fine‐needle biopsy of solid pancreatic lesions after previous nondiagnostic or inconclusive sampling

Author:

Lisotti Andrea1ORCID,Cominardi Anna12,Conti Bellocchi Maria Cristina3,Crinò Stefano Francesco3ORCID,Larghi Alberto4,Facciorusso Antonio5,Arcidiacono Paolo Giorgio6,De Angelis Claudio7,Di Matteo Francesco Maria8,Fabbri Carlo9,Bertani Helga10,Togliani Thomas11ORCID,Rizzatti Gianenrico4,Brancaccio Mario12,Grillo Antonino13,Fantin Alberto14,Pezzoli Alessandro15,D'Errico Francesca16,Amato Arnaldo17,Antonini Filippo18ORCID,Montale Amedeo19,Pisani Antonio20,Forti Edoardo21,Manno Mauro22,Carrara Silvia23,Petrone Maria Chiara6,Binda Cecilia9ORCID,Zagari Rocco Maurizio2425,Fusaroli Pietro1,

Affiliation:

1. Gastroenterology Unit, Hospital of Imola University of Bologna Imola Italy

2. Gastroenterology Unit Hospital of Piacenza Piacenza Italy

3. Digestive Endoscopy Unit University of Verona Verona Italy

4. Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy

5. Gastroenterology Unit, Department of Surgical and Medical Sciences University of Foggia Foggia Italy

6. IRCCS San Raffaele Scientific Institute Vita‐Salute San Raffaele University Milan Italy

7. Department of General and Specialist Medicine, Gastroenterologia‐U Città della Salute e della Scienza di Torino Turin Italy

8. Operative Endoscopy Department, Campus Bio‐Medico University Hospital Rome Italy

9. Gastroenterology and Digestive Endoscopy Unit, Forlì‐Cesena Hospitals AUSL Romagna Forli Italy

10. Gastroenterology and Digestive Endoscopy Unit Azienda Ospedaliero Universitaria di Modena Modena Italy

11. Gastroenterology and Digestive Endoscopy Unit University Hospital Borgo Trento Verona Italy

12. Unit of Gastroenterology, Santa Maria delle Croci Hospital AUSL Romagna Ravenna Italy

13. Gastroenterology and Digestive Endoscopy Unit, Rimini “Infermi” Hospital AUSL Romagna Rimini Italy

14. Gastroenterology Unit Veneto Institute of Oncology IOV‐IRCCS Padua Italy

15. Department of Gastroenterology and GI Endoscopy University Hospital Ferrara Italy

16. Gastroenterology and Endoscopy Unit, Ente Ecclesiastico F. Miulli Acquaviva delle Fonti Bari Italy

17. Division of Digestive Endoscopy and Gastroenterology Valduce Hospital Como Italy

18. Gastroenterology and Interventional Endoscopy Unit “C. e G. Mazzoni” Hospital Ascoli Piceno Italy

19. Division of Gastroenterology E.O. Galliera Hospital Genoa Italy

20. National Institute of Gastroenterology IRCCS Saverio de Bellis Castellana Grotte, Bari Italy

21. Digestive Endoscopy Unit ASST Niguarda Milan Italy

22. Gastroenterology and Digestive Endoscopy Unit Azienda USL Modena Modena Italy

23. Endoscopic Unit, Department of Gastroenterology IRCCS Humanitas Research Hospital Milan Italy

24. SSD “Patologie organiche esofago‐gastriche”, IRCCS Azienda Ospedaliero‐Universitaria di Bologna S. Orsola Hospital Bologna Italy

25. Department of Medical and Surgical Sciences – DIMEC University of Bologna Bologna Italy

Abstract

ObjectivesRepeated endoscopic ultrasound (EUS)‐guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine‐needle biopsy (rEUS‐FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes.MethodsConsecutive patients undergoing rEUS‐FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6‐month follow‐up, and benign pathology together with ≥12‐month follow‐up were adopted as gold standards.ResultsAmong 462 patients, 56.5% were male, with a median age of 68 (59–75) years, malignancy prevalence 77.0%. Tumor size was 26 (20–35) mm. Second‐generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS‐FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false‐negative and 12 false‐positive results). On multivariate analysis, rEUS‐FNB performed at high‐volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10–3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00–1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second‐generation FNB needles (OR 5.42; 95% CI 2.30–12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31–7.06; P = 0.009) were independently related to sample adequacy.ConclusionRepeated EUS‐FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high‐volume centers improved diagnostic accuracy. The use of second‐generation FNB needles significantly improved sample adequacy over standard EUS‐FNB needles.

Publisher

Wiley

Subject

Gastroenterology,Radiology, Nuclear Medicine and imaging

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