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Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study.
Endosc Int Open 2018; 6(12):E1423-E1430EI

Abstract

Background and study aims Accurate diagnosis and classification of pancreatic cysts (PCs) remains a challenge. The aims of this study were to: (1) evaluate the safety and technical success of a novel microforceps for EUS-guided through-the-needle biopsy (TTNB) of PCs; and (2) assess its diagnostic yield for mucinous PCs when compared to FNA cyst fluid analysis and cytology. Patients and methods This was a multicenter retrospective analysis of 47 patients who underwent EUS-FNA and TTNB for PCs between January 2014 and June 2017. Technical success was defined as acquisition of a specimen adequate for cytologic or histological evaluation. Cyst fluid carcinoembryonic antigen (CEA) was used to initially categorize cysts as non-mucinous (CEA < 192 ng/mL) or mucinous (CEA ≥ 192 ng/mL). Final diagnosis was based on identifiable mucinous pancreatic cystic epithelium on cytology, microforceps histology and/or surgical histology when available. Results Forty-seven patients with PCs (mean size 30.7 mm) were included. TTNB was successfully performed in 46 of 47 (97.9 %). Technical success was significantly lower with FNA (48.9 %) compared to TTNB (85.1 %) (P < .001). For cysts with insufficient amount of fluid for CEA (n = 19) or CEA < 192 ng/mL, the cumulative incremental diagnostic yield of a mucinous PC was significantly higher with TTNB vs. FNA (52.6 % vs 18.4 %; P = .004). TTNB alone (34.4 %) diagnosed more mucinous PCs than either CEA ≥ 192 ng/mL alone (6.3 %) or when combined with FNA cytology (9.4 %). One episode of self-limited bleeding (2.1 %) and one of pancreatitis (2.1 %) occurred. Conclusions EUS-TTNB is safe and effective for evaluating PCs. TTNB may help increase the diagnostic yield of mucinous PCs.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States.Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, California, United States.Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, California, United States.Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, California, United States.Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, California, United States.Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, California, United States.Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, California, United States.Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, California, United States.Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, California, United States.Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30574535

Citation

Yang, Dennis, et al. "Endoscopic Ultrasound-guided Through-the-needle Microforceps Biopsy in the Evaluation of Pancreatic Cystic Lesions: a Multicenter Study." Endoscopy International Open, vol. 6, no. 12, 2018, pp. E1423-E1430.
Yang D, Samarasena JB, Jamil LH, et al. Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. Endosc Int Open. 2018;6(12):E1423-E1430.
Yang, D., Samarasena, J. B., Jamil, L. H., Chang, K. J., Lee, D., Ona, M. A., ... Draganov, P. V. (2018). Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. Endoscopy International Open, 6(12), pp. E1423-E1430. doi:10.1055/a-0770-2700.
Yang D, et al. Endoscopic Ultrasound-guided Through-the-needle Microforceps Biopsy in the Evaluation of Pancreatic Cystic Lesions: a Multicenter Study. Endosc Int Open. 2018;6(12):E1423-E1430. PubMed PMID: 30574535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. AU - Yang,Dennis, AU - Samarasena,Jason B, AU - Jamil,Laith H, AU - Chang,Kenneth J, AU - Lee,David, AU - Ona,Mel A, AU - Lo,Simon K, AU - Gaddam,Srinivas, AU - Liu,Quin, AU - Draganov,Peter V, Y1 - 2018/12/05/ PY - 2018/05/08/received PY - 2018/07/24/accepted PY - 2018/12/22/entrez PY - 2018/12/24/pubmed PY - 2018/12/24/medline SP - E1423 EP - E1430 JF - Endoscopy international open JO - Endosc Int Open VL - 6 IS - 12 N2 - Background and study aims Accurate diagnosis and classification of pancreatic cysts (PCs) remains a challenge. The aims of this study were to: (1) evaluate the safety and technical success of a novel microforceps for EUS-guided through-the-needle biopsy (TTNB) of PCs; and (2) assess its diagnostic yield for mucinous PCs when compared to FNA cyst fluid analysis and cytology. Patients and methods This was a multicenter retrospective analysis of 47 patients who underwent EUS-FNA and TTNB for PCs between January 2014 and June 2017. Technical success was defined as acquisition of a specimen adequate for cytologic or histological evaluation. Cyst fluid carcinoembryonic antigen (CEA) was used to initially categorize cysts as non-mucinous (CEA < 192 ng/mL) or mucinous (CEA ≥ 192 ng/mL). Final diagnosis was based on identifiable mucinous pancreatic cystic epithelium on cytology, microforceps histology and/or surgical histology when available. Results Forty-seven patients with PCs (mean size 30.7 mm) were included. TTNB was successfully performed in 46 of 47 (97.9 %). Technical success was significantly lower with FNA (48.9 %) compared to TTNB (85.1 %) (P < .001). For cysts with insufficient amount of fluid for CEA (n = 19) or CEA < 192 ng/mL, the cumulative incremental diagnostic yield of a mucinous PC was significantly higher with TTNB vs. FNA (52.6 % vs 18.4 %; P = .004). TTNB alone (34.4 %) diagnosed more mucinous PCs than either CEA ≥ 192 ng/mL alone (6.3 %) or when combined with FNA cytology (9.4 %). One episode of self-limited bleeding (2.1 %) and one of pancreatitis (2.1 %) occurred. Conclusions EUS-TTNB is safe and effective for evaluating PCs. TTNB may help increase the diagnostic yield of mucinous PCs. SN - 2364-3722 UR - https://www.unboundmedicine.com/medline/citation/30574535/Endoscopic_ultrasound_guided_through_the_needle_microforceps_biopsy_in_the_evaluation_of_pancreatic_cystic_lesions:_a_multicenter_study_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/a-0770-2700 DB - PRIME DP - Unbound Medicine ER -