Journal Article

An Exclusive Fine Needle Biopsy Approach to Sampling Solid Lesions Under EUS Guidance: A Case-Controlled Study

Patel, Harsh, Temnykh, Lindsey, Rahal, Mahmoud, Al-Haddad, Mohammad, Zia, Zahra

2018

Overview

Introduction: Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) is increasingly utilized to enhance cytological yield of sampling solid lesions under EUS. The impact of a \"FNB-only\" approach in sampling all solid lesions on procedural outcomes has not been reported. Methods: Consecutive patients with solid lesions referred for EUS guided sampling were included. Procedure related outcomes were collected prospectively including patient demographics, procedure duration (from initiation to termination of sedation), sedative doses used, number of passes performed, diagnostic sample adequacy, complications (including post-procedure hospitalizations and emergency department visits) and recovery time. The Acquire FNB needle (Boston Scientific, Natick, MA) was used to sample all lesions in the study group. Tissue was processed on-site with touch or crush preps, with all excess visible cores placed in a cellular preservative for cell block. Additional passes were allocated to cellblock based on the results of the rapid on-site evaluation (ROSE). Consecutive EUS-FNA procedures recently performed to sample solid lesions using the Expect needle (Boston Scientific, Natick, MA) were utilized as controls, and the same procedure related outcomes were abstracted from our clinical databases. Results: 180 patients underwent EUS-FNB and comprised the FNB intervention group. This was compared to 183 recent FNA procedures for solid lesion sampling. There was no difference in age, gender, antibiotic use, or ASA class between the 2 groups. The number of passes was significantly lower in patients who had EUS-FNB compared to EUS-FNA (2.9 vs 3.8, p<0.001). Also, the number of samples obtained as an adequate diagnostic specimen was significantly higher in the patients who underwent EUS-FNB compared to EUS-FNA (177 vs 165, p=0.003) There was no significant difference in the Propofol dose used, recovery time, or rate of complications between both groups. Conclusion: An FNB-exclusive approach to sampling solid lesions under EUS is feasible and may result in fewer overall passes and increased diagnostic adequacy and may obviate the need for on-site pathology review given the high diagnostic yield. FNB may replace FNA as the primary sampling modality of choice in all solid lesions.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Biopsy / Gastroenterology / Onsite