Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts.

Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods Female Follow-Up Studies Humans Male Middle Aged Pancreas / pathology Pancreatic Cyst / diagnosis Prospective Studies Reproducibility of Results
CEA Comparison Fluid Analysis Pancreas Pancreas Cancer

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
07 2019
Historique:
received: 01 10 2018
revised: 01 11 2018
accepted: 02 11 2018
pubmed: 25 11 2018
medline: 22 10 2020
entrez: 25 11 2018
Statut: ppublish

Résumé

It is a challenge to accurately assess pancreatic cystic lesions (PCLs) and determine their risk. We compared the yield of tissue acquired with endoscopic ultrasound (EUS)-guided microforceps (through the needle tissue biopsy [TTNB]) with that of samples collected by EUS-guided fine-needle-aspiration (EUS-FNA), and the accuracy of analyses of each sample type in the diagnosis of mucinous PCLs. We performed a prospective open-label study of 114 consecutive adults (56.1% women; mean age, 64.2 y) undergoing EUS-FNA evaluation of PCLs (mean size, 35 mm) at 7 centers, from June 20, 2016, through August 31, 2018. Samples were collected from each cyst by FNA and microforceps; samples collected by FNA were analyzed by cytology and samples collected by TTNB were analyzed by histology. Acquisition yield was defined as the percentage of specimens collected that were adequate for cytologic or histologic analysis. Diagnoses of mucinous cysts were made based on identification of pancreatic mucinous epithelium by cytology analysis of FNA samples or histologic analysis of TTNB samples. Surgical specimens were used as the reference standard when available. The EUS-guided microforceps were successfully inserted into 97.4% (111 of 114) of PCLs. Tissue acquisition yield was significantly higher with TTNB (95 of 114; 83.3%) than FNA (43 of 114; 37.7%) (P < .001). Sixty-one PCLs were determined to be mucinous based on TTNB analysis (53.5%) vs 11 with FNA analysis (9.6%) (P < .001). Among PCLs categorized as equivocal, based on the level of carcinoembryonic antigen, TTNB analysis found 50% (41 of 82) to be mucinous and FNA analysis found 8.5% (7 of 82) to be mucinous (P < .001). Findings from analyses of samples collected by TTNB were 100% concordant with findings from histologic analysis of surgical specimens (14 of 14), whereas only 3 of 14 findings from analysis of samples collected by FNA were in agreement with findings from surgical specimens (21.4%) (P < .001). Four of 5 mucinous PCLs with advanced neoplasia (80%) were detected with TTNB compared with none with FNA (P = .04). Self-limited intracystic bleeding occurred in 7 patients (6.1%), and acute pancreatitis in 6 patients (5.3%). In a multicenter prospective study of patients undergoing EUS-FNA for evaluation of PCLs, we found TTNB collection of tissues for histologic analysis to be safe and feasible, with an acquisition yield of 83.3%. Histologic analysis of samples collected by TTNB identified a larger proportion of mucinous PCLs compared with cytologic analysis of samples collected by FNA-even among samples categorized as equivocal, based on the level of carcinoembryonic antigen. More samples collected by TTNB than FNA were found to have advanced neoplasia. Clinicaltrials.gov no: NCT02979509.

Sections du résumé

BACKGROUND & AIMS
It is a challenge to accurately assess pancreatic cystic lesions (PCLs) and determine their risk. We compared the yield of tissue acquired with endoscopic ultrasound (EUS)-guided microforceps (through the needle tissue biopsy [TTNB]) with that of samples collected by EUS-guided fine-needle-aspiration (EUS-FNA), and the accuracy of analyses of each sample type in the diagnosis of mucinous PCLs.
METHODS
We performed a prospective open-label study of 114 consecutive adults (56.1% women; mean age, 64.2 y) undergoing EUS-FNA evaluation of PCLs (mean size, 35 mm) at 7 centers, from June 20, 2016, through August 31, 2018. Samples were collected from each cyst by FNA and microforceps; samples collected by FNA were analyzed by cytology and samples collected by TTNB were analyzed by histology. Acquisition yield was defined as the percentage of specimens collected that were adequate for cytologic or histologic analysis. Diagnoses of mucinous cysts were made based on identification of pancreatic mucinous epithelium by cytology analysis of FNA samples or histologic analysis of TTNB samples. Surgical specimens were used as the reference standard when available.
RESULTS
The EUS-guided microforceps were successfully inserted into 97.4% (111 of 114) of PCLs. Tissue acquisition yield was significantly higher with TTNB (95 of 114; 83.3%) than FNA (43 of 114; 37.7%) (P < .001). Sixty-one PCLs were determined to be mucinous based on TTNB analysis (53.5%) vs 11 with FNA analysis (9.6%) (P < .001). Among PCLs categorized as equivocal, based on the level of carcinoembryonic antigen, TTNB analysis found 50% (41 of 82) to be mucinous and FNA analysis found 8.5% (7 of 82) to be mucinous (P < .001). Findings from analyses of samples collected by TTNB were 100% concordant with findings from histologic analysis of surgical specimens (14 of 14), whereas only 3 of 14 findings from analysis of samples collected by FNA were in agreement with findings from surgical specimens (21.4%) (P < .001). Four of 5 mucinous PCLs with advanced neoplasia (80%) were detected with TTNB compared with none with FNA (P = .04). Self-limited intracystic bleeding occurred in 7 patients (6.1%), and acute pancreatitis in 6 patients (5.3%).
CONCLUSIONS
In a multicenter prospective study of patients undergoing EUS-FNA for evaluation of PCLs, we found TTNB collection of tissues for histologic analysis to be safe and feasible, with an acquisition yield of 83.3%. Histologic analysis of samples collected by TTNB identified a larger proportion of mucinous PCLs compared with cytologic analysis of samples collected by FNA-even among samples categorized as equivocal, based on the level of carcinoembryonic antigen. More samples collected by TTNB than FNA were found to have advanced neoplasia. Clinicaltrials.gov no: NCT02979509.

Identifiants

DOI: 10.1016/j.cgh.2018.11.027 PMID: 30471456
pubmed: 30471456
pii: S1542-3565(18)31270-9
doi: 10.1016/j.cgh.2018.11.027
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02979509']

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

IM

Pagination

1587-1596

Subventions

Organisme : NIDDK NIH HHS
ID : P30 DK058404
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Dennis Yang (D)

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida. Electronic address: dennis.yang@medicine.ufl.edu.

Arvind J Trindade (AJ)

Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York.

Patrick Yachimski (P)

Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.

Petros Benias (P)

Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York.

Jose Nieto (J)

Borland-Groover Clinic, Jacksonville, Florida.

Amar Manvar (A)

Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Sammy Ho (S)

Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Ashwini Esnakula (A)

Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida.

Anthony Gamboa (A)

Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.

Amrita Sethi (A)

Division of Digestive and Liver Disease, Columbia University, Medical Center-New York Presbyterian Hospital, New York, New York.

Anand Gupte (A)

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.

Harshit S Khara (HS)

Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania.

David L Diehl (DL)

Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania.

Abdul El Chafic (A)

Division of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana.

Janak Shah (J)

Division of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana.

Christopher E Forsmark (CE)

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.

Peter V Draganov (PV)

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida.

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Classifications MeSH

questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Biopsie guidée par l'image › Cytoponction sous échoendoscopie › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études de suivi › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Système digestif › Pancréas › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du pancréas › Kyste du pancréas › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Histologic Analysis of Endoscopic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Reproductibilité des résultats › Histologic Analysis of Endoscopic...