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Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts.
Clin Gastroenterol Hepatol 2019; 17(8):1587-1596CG

Abstract

BACKGROUND & AIMS

It is a challenge to accurately assess pancreatic cystic lesions (PCLs) and determine their risk. We compared the yield of tissue acquired with endoscopic ultrasound (EUS)-guided microforceps (through the needle tissue biopsy [TTNB]) with that of samples collected by EUS-guided fine-needle-aspiration (EUS-FNA), and the accuracy of analyses of each sample type in the diagnosis of mucinous PCLs.

METHODS

We performed a prospective open-label study of 114 consecutive adults (56.1% women; mean age, 64.2 y) undergoing EUS-FNA evaluation of PCLs (mean size, 35 mm) at 7 centers, from June 20, 2016, through August 31, 2018. Samples were collected from each cyst by FNA and microforceps; samples collected by FNA were analyzed by cytology and samples collected by TTNB were analyzed by histology. Acquisition yield was defined as the percentage of specimens collected that were adequate for cytologic or histologic analysis. Diagnoses of mucinous cysts were made based on identification of pancreatic mucinous epithelium by cytology analysis of FNA samples or histologic analysis of TTNB samples. Surgical specimens were used as the reference standard when available.

RESULTS

The EUS-guided microforceps were successfully inserted into 97.4% (111 of 114) of PCLs. Tissue acquisition yield was significantly higher with TTNB (95 of 114; 83.3%) than FNA (43 of 114; 37.7%) (P < .001). Sixty-one PCLs were determined to be mucinous based on TTNB analysis (53.5%) vs 11 with FNA analysis (9.6%) (P < .001). Among PCLs categorized as equivocal, based on the level of carcinoembryonic antigen, TTNB analysis found 50% (41 of 82) to be mucinous and FNA analysis found 8.5% (7 of 82) to be mucinous (P < .001). Findings from analyses of samples collected by TTNB were 100% concordant with findings from histologic analysis of surgical specimens (14 of 14), whereas only 3 of 14 findings from analysis of samples collected by FNA were in agreement with findings from surgical specimens (21.4%) (P < .001). Four of 5 mucinous PCLs with advanced neoplasia (80%) were detected with TTNB compared with none with FNA (P = .04). Self-limited intracystic bleeding occurred in 7 patients (6.1%), and acute pancreatitis in 6 patients (5.3%).

CONCLUSIONS

In a multicenter prospective study of patients undergoing EUS-FNA for evaluation of PCLs, we found TTNB collection of tissues for histologic analysis to be safe and feasible, with an acquisition yield of 83.3%. Histologic analysis of samples collected by TTNB identified a larger proportion of mucinous PCLs compared with cytologic analysis of samples collected by FNA-even among samples categorized as equivocal, based on the level of carcinoembryonic antigen. More samples collected by TTNB than FNA were found to have advanced neoplasia. Clinicaltrials.gov no: NCT02979509.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida. Electronic address: dennis.yang@medicine.ufl.edu.Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York.Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York.Borland-Groover Clinic, Jacksonville, Florida.Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida.Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.Division of Digestive and Liver Disease, Columbia University, Medical Center-New York Presbyterian Hospital, New York, New York.Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania.Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania.Division of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana.Division of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana.Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30471456

Citation

Yang, Dennis, et al. "Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 17, no. 8, 2019, pp. 1587-1596.
Yang D, Trindade AJ, Yachimski P, et al. Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. Clin Gastroenterol Hepatol. 2019;17(8):1587-1596.
Yang, D., Trindade, A. J., Yachimski, P., Benias, P., Nieto, J., Manvar, A., ... Draganov, P. V. (2019). Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 17(8), pp. 1587-1596. doi:10.1016/j.cgh.2018.11.027.
Yang D, et al. Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. Clin Gastroenterol Hepatol. 2019;17(8):1587-1596. PubMed PMID: 30471456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. AU - Yang,Dennis, AU - Trindade,Arvind J, AU - Yachimski,Patrick, AU - Benias,Petros, AU - Nieto,Jose, AU - Manvar,Amar, AU - Ho,Sammy, AU - Esnakula,Ashwini, AU - Gamboa,Anthony, AU - Sethi,Amrita, AU - Gupte,Anand, AU - Khara,Harshit S, AU - Diehl,David L, AU - El Chafic,Abdul, AU - Shah,Janak, AU - Forsmark,Christopher E, AU - Draganov,Peter V, Y1 - 2018/11/22/ PY - 2018/10/01/received PY - 2018/11/01/revised PY - 2018/11/02/accepted PY - 2018/11/25/pubmed PY - 2018/11/25/medline PY - 2018/11/25/entrez KW - CEA KW - Comparison KW - Fluid Analysis KW - Pancreas KW - Pancreas Cancer SP - 1587 EP - 1596 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 17 IS - 8 N2 - BACKGROUND & AIMS: It is a challenge to accurately assess pancreatic cystic lesions (PCLs) and determine their risk. We compared the yield of tissue acquired with endoscopic ultrasound (EUS)-guided microforceps (through the needle tissue biopsy [TTNB]) with that of samples collected by EUS-guided fine-needle-aspiration (EUS-FNA), and the accuracy of analyses of each sample type in the diagnosis of mucinous PCLs. METHODS: We performed a prospective open-label study of 114 consecutive adults (56.1% women; mean age, 64.2 y) undergoing EUS-FNA evaluation of PCLs (mean size, 35 mm) at 7 centers, from June 20, 2016, through August 31, 2018. Samples were collected from each cyst by FNA and microforceps; samples collected by FNA were analyzed by cytology and samples collected by TTNB were analyzed by histology. Acquisition yield was defined as the percentage of specimens collected that were adequate for cytologic or histologic analysis. Diagnoses of mucinous cysts were made based on identification of pancreatic mucinous epithelium by cytology analysis of FNA samples or histologic analysis of TTNB samples. Surgical specimens were used as the reference standard when available. RESULTS: The EUS-guided microforceps were successfully inserted into 97.4% (111 of 114) of PCLs. Tissue acquisition yield was significantly higher with TTNB (95 of 114; 83.3%) than FNA (43 of 114; 37.7%) (P < .001). Sixty-one PCLs were determined to be mucinous based on TTNB analysis (53.5%) vs 11 with FNA analysis (9.6%) (P < .001). Among PCLs categorized as equivocal, based on the level of carcinoembryonic antigen, TTNB analysis found 50% (41 of 82) to be mucinous and FNA analysis found 8.5% (7 of 82) to be mucinous (P < .001). Findings from analyses of samples collected by TTNB were 100% concordant with findings from histologic analysis of surgical specimens (14 of 14), whereas only 3 of 14 findings from analysis of samples collected by FNA were in agreement with findings from surgical specimens (21.4%) (P < .001). Four of 5 mucinous PCLs with advanced neoplasia (80%) were detected with TTNB compared with none with FNA (P = .04). Self-limited intracystic bleeding occurred in 7 patients (6.1%), and acute pancreatitis in 6 patients (5.3%). CONCLUSIONS: In a multicenter prospective study of patients undergoing EUS-FNA for evaluation of PCLs, we found TTNB collection of tissues for histologic analysis to be safe and feasible, with an acquisition yield of 83.3%. Histologic analysis of samples collected by TTNB identified a larger proportion of mucinous PCLs compared with cytologic analysis of samples collected by FNA-even among samples categorized as equivocal, based on the level of carcinoembryonic antigen. More samples collected by TTNB than FNA were found to have advanced neoplasia. Clinicaltrials.gov no: NCT02979509. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/30471456/Histologic_Analysis_of_Endoscopic_Ultrasound_Guided_Through_the_Needle_Microforceps_Biopsies_Accurately_Identifies_Mucinous_Pancreas_Cysts_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(18)31270-9 DB - PRIME DP - Unbound Medicine ER -