Tu1407 EUS-THROUGH-THE-NEEDLE BIOPSY (EUS-TTNB) IN PANCREATIC CYSTIC LESIONS - A LARGE SINGLE CENTER EXPERIENCE

Rintaro Hashimoto; Nabil E. Chehade; Elise Tran; Kenneth J. Chang; John Lee; Jason B. Samarasena

doi:10.1016/j.gie.2019.03.1064

Background Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, EUS-through-the-needle biopsy (EUS-TTNB) using microforceps (MorayTM microforceps, US Endoscopy, Ohio, USA) in PCLs has been made available. There still remains limited data regarding the efficacy and its safety profile. The aim of this study is to evaluate EUS-TTNB in terms of efficacy, diagnostic yield, and safety in the diagnosis of PCLs. A secondary aim is to evaluate the additive value in diagnostic yield over standard EUS-FNA. Methods We retrospectively collected data of patients with PCLs who underwent both EUS-FNA for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis. Results A total of 56 patients (mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8mm (12-85 mm). Cysts were in the uncinate (4 patients), head (13), neck (16), body (7) and tail (16). The average number of biopsies taken during EUS-TTNB was 3.14 per patient. The EUS-TTNB procedure was technically successful in all patients (100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA, respectively 80.4% (45/56) vs 25% (14/56). There was one case of neuroendocrine tumor that was diagnosed by TTNB, which was not demonstrated by cytologic analysis. TTNB changed the diagnosis in one patient from mucinous cystadenoma to serous cystadenoma. Using TTNB specimens, 23 cases of intraductal papillary mucinous neoplasm were further differentiated into gastric type (19 patients) and pancreaticobiliary type (4 patients) based on immunochemical staining. Interestingly, there was discordance between CEA and TTNB results. Fluid CEA analysis was available in 38/53 PCLs (71.7%). For the 25 PCLs with CEA < 192 ng/mL indicating a non-mucinous cyst, TTNB provided a diagnosis of mucinous cyst in 13/25 (52%) while EUS FNA provided a mucinous cyst diagnosis in 3/25 with FNA (12%) (p<0.01). Adverse events occurred in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Conclusions In this study, EUS-TTNB for PCLs was technically feasible and had a favorable safety profile. Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid CEA. EUS-TTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.

Tu1407 EUS-THROUGH-THE-NEEDLE BIOPSY (EUS-TTNB) IN PANCREATIC CYSTIC LESIONS - A LARGE SINGLE CENTER EXPERIENCE

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