Clinical usefulness of tissue acquisition of pancreatic cystic lesions using an endoscopic ultrasound-guided needle for histological analysis

Juliana Silveira Lima de Castro; Eloy Taglieri; Otávio Micelli Neto; João Guilherme Guerra; Filadélfio Euclides Venco; Eliza Andrade; Alvaro Moura Seraphim; Samuel Galante Romanini; Isabela Trindade Torres; Juan Pablo Roman Serrano; Suzan Menasce Goldman; Rafael Kemp; José Sebastião Dos Santos; José Celso Ardengh

doi:10.1055/a-2240-0678

Clinical usefulness of tissue acquisition of pancreatic cystic lesions using an endoscopic ultrasound-guided needle for histological analysis

Endosc Int Open. 2024 Jan 30;12(1):E155-E163. doi: 10.1055/a-2240-0678. eCollection 2024 Jan.

Authors

Juliana Silveira Lima de Castro^{1

2}, Eloy Taglieri^{2

3

4}, Otávio Micelli Neto^{2

3

4}, João Guilherme Guerra^{2

3}, Filadélfio Euclides Venco⁵, Eliza Andrade², Alvaro Moura Seraphim², Samuel Galante Romanini⁴, Isabela Trindade Torres⁴, Juan Pablo Roman Serrano⁶, Suzan Menasce Goldman¹, Rafael Kemp⁷, José Sebastião Dos Santos⁷, José Celso Ardengh^{1

3

7}

Affiliations

¹ Diagnostic Imaging, Universidade Federal de Sao Paulo Departamento de Diagnostico por Imagem, Sao Paulo, Brazil.
² Endoscopy, ACCamargo Cancer Center, Sao Paulo, Brazil.
³ Endoscopy, Hospital Moriah, Sao Paulo, Brazil.
⁴ Endoscopy, Hospital 9 de Julho, Sao Paulo, Brazil.
⁵ Pathology, Hospital Moriah, Sao Paulo, Brazil.
⁶ Endoscopy, Hospital General Luis Vernaza, Guayaquil, Ecuador.
⁷ Surgery and Anatomy, Universidade de Sao Paulo Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, Brazil.

Abstract

Background and study aims There are rare data on the usefulness of endosonography-guided tissue acquisition (EUS-TA) in patients with pancreatic cystic lesions (PCLs). This study aimed to determine the accuracy of EUS-TA with ProCore 20G (PC20) for differentiating between mucinous neoplasia (MN) and non-MNs (n-MN) and identifying malignant PCLs, as well as its adverse events (AEs) in patients with PCLs without a classificatory diagnosis by imaging exams. Patients and methods In this observational, retrospective, single-center study, all patients with PCL who underwent EUS-TA due to diagnostic doubts in imaging studies were consecutively recruited from June 2017 to December 2021. The outcomes were to determine the diagnostic accuracy of EUS-TA with PC20 for differentiating between MN and n-MN, identifying malignant PCLs, and the AEs. Results Herein, 145 patients underwent EUS-TA, with 83 women (57.2%) and a mean age of 62.2 years. The mean size was 2.3 cm, with 81 patients (77.9%) having a PCL < 3.0 cm. The final diagnosis was made by EUS-TA (n = 81), surgery (n = 58), and follow-up (n = 6). The sensitivity, specificity, positive and negative predictive values, and accuracy for differentiating between MNs and n-MNs and identifying malignant PCLs were 92.6%, 98.4%, 98.7%, 91.3%, and 95.2% (kappa=0.9), and 92%, 99.2%, 95.8%, 98.3%, and 97.9% (kappa = 0.93), respectively. The AE rate was 2.7%, with no deaths in this cohort. Conclusions EUS-TA with PC20 has high accuracy and technical success with a low AE rate for PCL diagnosis.

Keywords: Endoscopic ultrasonography; Fine-needle aspiration/biopsy; Intervention EUS; Pancreas; Tissue diagnosis.

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