In memoriam - fine needle aspiration, Birth - fine needle biopsy:The changing trend in endoscopic ultrasound-guided tissue acquisition.

OBJECTIVES: Fine needle aspiration (FNA) cytology has been the preferred technique for procuring tissue at endoscopic ultrasound (EUS) procedures for the past 25 years. To overcome some of the limitations of FNA cytology, fine needle biopsy (FNB) has been recently developed to yield histological tissue. Main objective was to compare the diagnostic yield of FNB compared to FNA for both onsite and offsite specimen assessment.

METHODS: A retrospective study was conducted at a single tertiary referral center to evaluate the outcomes of FNA and FNB over a 4-year period. EUS-guided tissue sampling was performed using 22 or 25G FNA needles from 2014-15 and 22G FNB needle was used from 2016-17.

RESULTS: Of 3,020 patients undergoing EUS-guided sampling of solid mass lesions (pancreatic masses 71.3%, other lesions 28.7%), FNA was performed in 68.9% and FNB in 31.1%. Median number of passes required for diagnostic adequacy on ROSE was significantly lower for FNB compared to FNA (1 [IQR 1-2] vs. 2 [IQR 1-3], p<0.001). Diagnostic yield on cell block was also significantly superior with FNB compared to FNA (92.3 vs. 71.1%, p<0.001). The superior performance of FNB over FNA was observed for both pancreatic (p<0.001) and non-pancreatic lesions (p<0.001).

CONCLUSIONS: Given these promising findings, in the future EUS-guided FNB will likely be the preferred technique for sampling of solid mass lesions. This article is protected by copyright. All rights reserved.