Scholarlink

Purpose <p>Endoscopic ultrasound with fine needle biopsy (EUS-FNB) has not been well studied in pancreatic cystic lesions (PCLs). This study evaluates the diagnostic performance of EUS-FNB for PCLs and its impact on management decisions.</p> Methods <p>We conducted a single-center, retrospective study of patients who had EUS-FNB between March 2016 and February 2024. We included patients with ≥ 6-month follow-up and excluded those with a solid pancreatic mass. We obtained clinical, radiologic, endoscopic, surgical, laboratory, and pathology data from chart review. We evaluated: (A) diagnostic yield; (B) predictors of diagnostic FNB; (C) diagnostic accuracy compared to surgical histopathology; (D) appropriateness of management decisions; and (E) adverse events. We compared the appropriateness of management decisions between diagnostic and non-diagnostic FNB.</p> Results <p>100 subjects underwent EUS-FNB for PCLs (56% microcystic or with mural nodule). FNB yielded a histologic diagnosis in 60% of sampled lesions. Performing 2 or more needle passes was the only significant predictor of a diagnostic FNB (<i>p</i> = 0.02). Compared to surgical histopathology (<i>n</i> = 21), FNB needles highly accurately diagnosed specific cyst types (IPMN = 85.7%, MCN = 90.5%, SCA = 95.2%, NET = 95.2%, SPN = 100%) and malignant PCLs (accuracy = 81.0%; specificity = 100%; sensitivity = 72.7%). There was a 7.2-fold increase of appropriate management decisions when FNB was diagnostic vs. non-diagnostic (<i>p</i> &lt; 0.001). This was due to improvement in surveillance discontinuation for benign cysts and in appropriate surgical resection for malignant PCLs (<i>p</i> &lt; 0.001). Post-FNB pancreatitis occurred in 4% of patients.</p> Conclusion <p>EUS-FNB accurately diagnoses different PCL types and their degree of neoplasia, leading to more appropriate management decisions. Future prospective studies are needed to confirm these findings.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Histologic Diagnosis of Pancreatic Cystic Lesions with Endoscopic Ultrasound Fine Needle Biopsy and Impact on Management Decisions

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年4月22日

查看全文
  • Ankit Mishra,
  • Thomas M. Hunold,
  • Dhiraj K. Peddu,
  • George M. Philips,
  • Erik-Jan Wamsteker,
  • Richard S. Kwon,
  • Allison R. Schulman,
  • Jiaqi Shi,
  • Eileen S. Carpenter,
  • Jorge D. Machicado

摘要

Purpose

Endoscopic ultrasound with fine needle biopsy (EUS-FNB) has not been well studied in pancreatic cystic lesions (PCLs). This study evaluates the diagnostic performance of EUS-FNB for PCLs and its impact on management decisions.

Methods

We conducted a single-center, retrospective study of patients who had EUS-FNB between March 2016 and February 2024. We included patients with ≥ 6-month follow-up and excluded those with a solid pancreatic mass. We obtained clinical, radiologic, endoscopic, surgical, laboratory, and pathology data from chart review. We evaluated: (A) diagnostic yield; (B) predictors of diagnostic FNB; (C) diagnostic accuracy compared to surgical histopathology; (D) appropriateness of management decisions; and (E) adverse events. We compared the appropriateness of management decisions between diagnostic and non-diagnostic FNB.

Results

100 subjects underwent EUS-FNB for PCLs (56% microcystic or with mural nodule). FNB yielded a histologic diagnosis in 60% of sampled lesions. Performing 2 or more needle passes was the only significant predictor of a diagnostic FNB (p = 0.02). Compared to surgical histopathology (n = 21), FNB needles highly accurately diagnosed specific cyst types (IPMN = 85.7%, MCN = 90.5%, SCA = 95.2%, NET = 95.2%, SPN = 100%) and malignant PCLs (accuracy = 81.0%; specificity = 100%; sensitivity = 72.7%). There was a 7.2-fold increase of appropriate management decisions when FNB was diagnostic vs. non-diagnostic (p < 0.001). This was due to improvement in surveillance discontinuation for benign cysts and in appropriate surgical resection for malignant PCLs (p < 0.001). Post-FNB pancreatitis occurred in 4% of patients.

Conclusion

EUS-FNB accurately diagnoses different PCL types and their degree of neoplasia, leading to more appropriate management decisions. Future prospective studies are needed to confirm these findings.