Gastroenterology: A new breakthrough in the diagnosis of "cancer king"-fine needle aspiration biopsy guided by endoscopic ultrasound

Endoscopic ultrasonography (EUS) guided fine needle aspiration (EUS-FNA) and rapid on-site assessment of cytology (ROSE) are effective diagnostic methods for evaluating solid pancreatic lesions (SPLs)
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However, the complexity of the development of expertise in pancreatic cytopathology and the associated costs limit the availability of ROSE in tertiary care centers

Endoscopic ultrasonography (EUS) guided fine needle aspiration (EUS-FNA) and rapid on-site assessment of cytology (ROSE) are effective diagnostic methods for evaluating solid pancreatic lesions (SPLs)

EUS-FNA

EUS-FNA

The latest generation of histological needles can be divided into modified needles with cutting edges and needles with a forward bevel with a window on the side
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Compared with standard FNA needles, all needles showed higher histology and diagnostic rates.

A recent randomized trial and a meta-analysis showed that compared with EUS-FNA+ROSE, EUS-guided fine needle biopsy (EUS-FNB) has the same diagnostic rate

However, in prospective studies, the diagnostic accuracy of EUS-FNB using the new FNB needle alone was greater than 90%, and there were no randomized trials to study the benefits of ROSE and TIC on FNB specimens

Researchers conducted a non-inferiority study (non-inferiority ratio of 5%) at 14 centers in 8 countries
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SPL patients requiring tissue sampling were randomly assigned (1:1) to receive EUS-FNB, use a new generation of FNB needle, or not use ROSE

Over a period of 18 months, 800 patients were randomly assigned, and 771 were subjected to the final data analysis (385 used ROSE, 386 did not)
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In general, the diagnostic accuracy of the two groups of patients was equivalent (96.

In general, the diagnostic accuracy of the two groups of patients was equivalent (96.

Non-inferior results of diagnostic accuracy
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At the same time, the safety and sample quality of histological specimens in the two groups were similar
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The core rate of EUS-FNB without ROSE was significantly higher (70.

The core rate of EUS-FNB without ROSE was significantly higher (70.

It can be seen that EUS-FNB shows high diagnostic accuracy when evaluating SPL, whether with or without ROSE

references:

Endoscopic Ultrasound--guided Fine-needle Biopsy With or Without Rapid On-site Evaluation for Diagnosis of Solid Pancreatic Lesions: A Randomized Controlled Non-Inferiority Trial.
https://doi.
org/10.
1053/j.
gastro.
2021.
06.
005

Endoscopic Ultrasound--guided Fine-needle Biopsy With or Without Rapid On-site Evaluation for Diagnosis of Solid Pancreatic Lesions: A Randomized Controlled Non-Inferiority Trial.
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