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Published online: 2025-01-14

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Endoscopic ultrasound-guided fine needle aspiration biopsy — diagnostic principles and workup

Małgorzata Lenarcik12, Magdalena Misiak-Gałązka23, Andrzej Mróz24

Abstract

Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is a well-recognized diagnostic tool of high sensitivity (60–95%) and specificity (85–100%) for diagnosing solid, cystic, and solid-cystic lesions in the gastrointestinal tract (esophagus, stomach, and intestines) or pancreas and biliary tract. The specificity may be lower though for lesions of smaller size or of difficult location.

The quality of received tissue increases with the endoscopist’s experience and proper application of the technique and the needles (e.g. vacuum aspiration); the key point for the diagnosis is high level cytomorphologic analysis performed by an experienced pathologist.

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References

  1. Bang JiY, Hebert-Magee S, Navaneethan U, et al. EUS-guided fine needle biopsy of pancreatic masses can yield true histology. Gut. 2018; 67(12): 2081–2084.
  2. Bang JiY, Navaneethan U, Hasan MK, et al. Endoscopic Ultrasound-guided Specimen Collection and Evaluation Techniques Affect Diagnostic Accuracy. Clin Gastroenterol Hepatol. 2018; 16(11): 1820–1828.e4.
  3. Gkolfakis P, Crinò SF, Tziatzios G, et al. Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc. 2022; 95(6): 1067–1077.e15.
  4. Chen YI, Chatterjee A, Berger R, et al. EUS-guided fine needle biopsy alone vs. EUS-guided fine needle aspiration with rapid on-site evaluation of cytopathology in pancreatic lesions: a multicenter randomized trial. Endoscopy. 2021; 54(1): 4–12.
  5. Facciorusso A, Sunny SP, Del Prete V, et al. Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: a meta-analysis. Gastrointest Endosc. 2020; 91(1): 14–22.e2.
  6. Facciorusso A, Crinò SF, Gkolfakis P, et al. Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis. Gastroenterol Rep (Oxf). 2022; 10: goac062.
  7. Facciorusso A, Del Prete V, Antonino M, et al. Diagnostic yield of Franseen and Fork-Tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis. Endosc Int Open. 2019; 7(10): E1221–E1230.
  8. Crinò S, Mitri RDi, Nguyen N, et al. 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. Gastroenterology. 2021; 161(3): 899–909.e5.
  9. Forbes N, Coelho-Prabhu N, Al-Haddad MA, et al. ASGE Standards of Practice Committee. Adverse events associated with EUS and EUS-guided procedures. Gastrointest Endosc. 2022; 95(1): 16–26.e2.
  10. Polkowski M, Jenssen C, Kaye P, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy. 2017; 49(10): 989–1006.
  11. Yang F, Liu E, Sun S. Rapid on-site evaluation (ROSE) with EUS-FNA: The ROSE looks beautiful. Endosc Ultrasound. 2019; 8(5): 283–287.
  12. Centeno BA. Diagnostic cytology of the biliary tract and ancreas. In: Odze RD, Goldblum JR. ed. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. 3rd ed. Saunders, Philadelphia 2015: 950–979.
  13. International Academy of Cytology-International Agency for Research on Cancer-World Health Organization Joint Editorial Board. WHO Reporting System for Pancreaticobiliary Cytopathology. vol. 2. 1st ed. International Agency for Research on Cancer 2022.
  14. Adsay NV, Klimstra DS. Chater 29. In: Odze RD, Goldblum JR. ed. Surgical pathology of the GI tract, liver, biliary tract, and pancreas. 3rd ed. Saunders, Philadelphia 2015: 803–820.
  15. Matthew R, Lindberg MD. Section 18, Tumor of the gastrointestinal tract. In: Lindberg LG. ed. Diagnostic pathology: Soft tissue tumors. 2nd ed. Saunders, Philadelphia 2016: 730–769.
  16. Rubin B, Hornick J. Mesenchymal Tumors of the Gastrointestinal Tract. Practical Soft Tissue Pathology: A Diagnostic Approach. 2013: 437–473.
  17. Layfield LJ, Pitman MB, DeMay RM, et al. Pancreaticobiliary tract cytology: Journey toward "Bethesda" style guidelines from the Papanicolaou Society of Cytopathology. Cytojournal. 2014; 11: 18.
  18. Pitman MB. The World Health Organization Reporting System for Pancreaticobiliary Cytopathology. Arch Pathol Lab Med. 2024 [Epub ahead of print].