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

Dennis Yang, Arvind J. Trindade, Patrick Yachimski, Petros Benias, Jose Nieto, Amar Manvar, Sammy Ho, Ashwini Esnakula, Anthony Gamboa, Amrita Sethi, Anand Gupte, Harshit S. Khara, David L. Diehl, Abdul El Chafic, Janak Shah, Christopher E. Forsmark, Peter V. Draganov

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1587-1596
Number of pages10
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number8
DOIs
StatePublished - Jul 1 2019

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Needle Biopsy
Cysts
Pancreas
Carcinoembryonic Antigen
Cell Biology
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreatitis
Multicenter Studies
Neoplasms
Histology
Epithelium

Keywords

  • CEA
  • Comparison
  • Fluid Analysis
  • Pancreas
  • Pancreas Cancer

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. / Yang, Dennis; Trindade, Arvind J.; Yachimski, Patrick; Benias, Petros; Nieto, Jose; Manvar, Amar; Ho, Sammy; Esnakula, Ashwini; Gamboa, Anthony; Sethi, Amrita; Gupte, Anand; Khara, Harshit S.; Diehl, David L.; El Chafic, Abdul; Shah, Janak; Forsmark, Christopher E.; Draganov, Peter V.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 8, 01.07.2019, p. 1587-1596.

Research output: Contribution to journalArticle

Yang, D, Trindade, AJ, Yachimski, P, Benias, P, Nieto, J, Manvar, A, Ho, S, Esnakula, A, Gamboa, A, Sethi, A, Gupte, A, Khara, HS, Diehl, DL, El Chafic, A, Shah, J, Forsmark, CE & Draganov, PV 2019, 'Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts', Clinical Gastroenterology and Hepatology, vol. 17, no. 8, pp. 1587-1596. https://doi.org/10.1016/j.cgh.2018.11.027
Yang, Dennis ; Trindade, Arvind J. ; Yachimski, Patrick ; Benias, Petros ; Nieto, Jose ; Manvar, Amar ; Ho, Sammy ; Esnakula, Ashwini ; Gamboa, Anthony ; Sethi, Amrita ; Gupte, Anand ; Khara, Harshit S. ; Diehl, David L. ; El Chafic, Abdul ; Shah, Janak ; Forsmark, Christopher E. ; Draganov, Peter V. / Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 8. pp. 1587-1596.
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abstract = "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.",
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author = "Dennis Yang and Trindade, {Arvind J.} and Patrick Yachimski and Petros Benias and Jose Nieto and Amar Manvar and Sammy Ho and Ashwini Esnakula and Anthony Gamboa and Amrita Sethi and Anand Gupte and Khara, {Harshit S.} and Diehl, {David L.} and {El Chafic}, Abdul and Janak Shah and Forsmark, {Christopher E.} and Draganov, {Peter V.}",
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TY - JOUR

T1 - Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts

AU - Yang, Dennis

AU - Trindade, Arvind J.

AU - Yachimski, Patrick

AU - Benias, Petros

AU - Nieto, Jose

AU - Manvar, Amar

AU - Ho, Sammy

AU - Esnakula, Ashwini

AU - Gamboa, Anthony

AU - Sethi, Amrita

AU - Gupte, Anand

AU - Khara, Harshit S.

AU - Diehl, David L.

AU - El Chafic, Abdul

AU - Shah, Janak

AU - Forsmark, Christopher E.

AU - Draganov, Peter V.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

KW - CEA

KW - Comparison

KW - Fluid Analysis

KW - Pancreas

KW - Pancreas Cancer

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