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Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions.

Abstract

BACKGROUND AND AIMS

EUS-guided through-the-needle biopsy (TTNB) sampling has been reported to improve diagnostic yield compared with cytology for the evaluation of pancreatic cystic lesions (PCLs). The number of macroscopically visible tissue samples needed to reach an adequate diagnosis is still unknown.

METHODS

This is a retrospective, single-center study on consecutive patients with PCLs with risk features (cyst >3 cm, thickened wall, cyst growth during follow-up, and mural nodules) who underwent TTNB sampling. The capability of differentiating mucinous versus nonmucinous cysts, ability to obtain a cyst-lining epithelium, definition of the grade of dysplasia, and specific diagnosis of cyst histotype were evaluated for 1, 2, or 3 TTNB macroscopically visible specimens.

RESULTS

Sixty-one patients were evaluated. A 100% histologic adequacy was reached by 2 samples (P = .05 versus 1). Compared with cytology, 1 TTNB specimen improved the possibility of defining cyst histotype (P < .0001), whereas 2 specimens increased all 4 diagnostic categories (P < .003). Two specimens also increased diagnostic yield compared with 1 sample (P < .085). The collection of a third sample did not improve the value of any diagnostic categories. A specific diagnosis was reached in 74% of patients with 2 histologic samples. The diagnostic reliability of TTNB sampling compared with surgical histology was 90%, with a 22.9% rate of adverse events.

CONCLUSIONS

Two TTNB macroscopically visible specimens reached 100% histologic adequacy and a specific diagnosis in 74% of patients. The collection of a third specimen did not add any additional information and should be avoided to possibly decrease the risk of adverse events.

Authors+Show Affiliations

Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy.Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy.Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy.Department of Pathology, Mater Salutis Hospital, Legnago, Verona, Italy.Digestive Endoscopy Unit, IRCCS, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy.Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31100310

Citation

Crinò, Stefano Francesco, et al. "Association Between Macroscopically Visible Tissue Samples and Diagnostic Accuracy of EUS-guided Through-the-needle Microforceps Biopsy Sampling of Pancreatic Cystic Lesions." Gastrointestinal Endoscopy, 2019.
Crinò SF, Bernardoni L, Brozzi L, et al. Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. Gastrointest Endosc. 2019.
Crinò, S. F., Bernardoni, L., Brozzi, L., Barresi, L., Malleo, G., Salvia, R., ... Manfrin, E. (2019). Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. Gastrointestinal Endoscopy, doi:10.1016/j.gie.2019.05.009.
Crinò SF, et al. Association Between Macroscopically Visible Tissue Samples and Diagnostic Accuracy of EUS-guided Through-the-needle Microforceps Biopsy Sampling of Pancreatic Cystic Lesions. Gastrointest Endosc. 2019 May 14; PubMed PMID: 31100310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. AU - Crinò,Stefano Francesco, AU - Bernardoni,Laura, AU - Brozzi,Lorenzo, AU - Barresi,Luca, AU - Malleo,Giuseppe, AU - Salvia,Roberto, AU - Frulloni,Luca, AU - Sina,Sokol, AU - Parisi,Alice, AU - Remo,Andrea, AU - Larghi,Alberto, AU - Gabbrielli,Armando, AU - Manfrin,Erminia, Y1 - 2019/05/14/ PY - 2019/01/28/received PY - 2019/05/06/accepted PY - 2019/5/18/pubmed PY - 2019/5/18/medline PY - 2019/5/18/entrez JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. N2 - BACKGROUND AND AIMS: EUS-guided through-the-needle biopsy (TTNB) sampling has been reported to improve diagnostic yield compared with cytology for the evaluation of pancreatic cystic lesions (PCLs). The number of macroscopically visible tissue samples needed to reach an adequate diagnosis is still unknown. METHODS: This is a retrospective, single-center study on consecutive patients with PCLs with risk features (cyst >3 cm, thickened wall, cyst growth during follow-up, and mural nodules) who underwent TTNB sampling. The capability of differentiating mucinous versus nonmucinous cysts, ability to obtain a cyst-lining epithelium, definition of the grade of dysplasia, and specific diagnosis of cyst histotype were evaluated for 1, 2, or 3 TTNB macroscopically visible specimens. RESULTS: Sixty-one patients were evaluated. A 100% histologic adequacy was reached by 2 samples (P = .05 versus 1). Compared with cytology, 1 TTNB specimen improved the possibility of defining cyst histotype (P < .0001), whereas 2 specimens increased all 4 diagnostic categories (P < .003). Two specimens also increased diagnostic yield compared with 1 sample (P < .085). The collection of a third sample did not improve the value of any diagnostic categories. A specific diagnosis was reached in 74% of patients with 2 histologic samples. The diagnostic reliability of TTNB sampling compared with surgical histology was 90%, with a 22.9% rate of adverse events. CONCLUSIONS: Two TTNB macroscopically visible specimens reached 100% histologic adequacy and a specific diagnosis in 74% of patients. The collection of a third specimen did not add any additional information and should be avoided to possibly decrease the risk of adverse events. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/31100310/Association_between_macroscopically_visible_tissue_samples_and_diagnostic_accuracy_of_EUS_guided_through_the_needle_microforceps_biopsy_sampling_of_pancreatic_cystic_lesions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(19)31690-6 DB - PRIME DP - Unbound Medicine ER -