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

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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.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-05-14 , DOI: 10.1016/j.gie.2019.05.009
Stefano Francesco Crinò ₁ , Laura Bernardoni ₁ , Lorenzo Brozzi ₁ , Luca Barresi ₂ , Giuseppe Malleo ₃ , Roberto Salvia ₃ , Luca Frulloni ₁ , Sokol Sina ₄ , Alice Parisi ₄ , Andrea Remo ₅ , Alberto Larghi ₆ , Armando Gabbrielli ₁ , Erminia Manfrin ₄

Affiliation

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.

中文翻译：

肉眼可见的组织样本与EUS引导的穿刺显微镊子活检样本对胰腺囊性病变的诊断准确性之间的关联。

背景和目标

EUS指导的穿刺活检（TTNB）采样与细胞学评估胰腺囊性病变（PCLs）相比，可提高诊断率。达到充分诊断所需的肉眼可见的组织样本数量仍然未知。

方法

这是一项回顾性，单中心研究，研究对象是连续进行了TTNB采样的具有危险特征（囊肿> 3 cm，壁增厚，随访期间的囊肿生长和壁瘤）的PCL患者。对于1、2或3个TTNB肉眼可见的标本，评估了区分粘液性囊肿与非粘液性囊肿的能力，获得囊肿衬里上皮的能力，发育异常等级的定义以及囊肿组织型的特异性诊断。

结果

评价了61例患者。2个样本达到了100％的组织学适应性（P = 0.05与1）。与细胞学相比，1个TTNB标本提高了确定囊肿组织型的可能性（P <.0001），而2个标本增加了所有4种诊断类别（P <.003）。与1个样品相比，两个样品也提高了诊断率（P <.085）。第三份样本的收集并没有提高任何诊断类别的价值。有2个组织学样本的患者中有74％达到了明确的诊断。与手术组织学相比，TTNB采样的诊断可靠性为90％，不良事件发生率为22.9％。