EUS-guided tissue acquisition in patients with solid pseudopapillary neoplasms of the pancreas.

OBJECTIVES: Endoscopic ultrasound-guided tissueacquisition (EUS-TA) has been the most common method used for the preoperativecytopathological diagnosis of solid tumors of the pancreas. There are only afew reported cases about the role of endoscopic ultrasound-guided fine needlebiopsy (EUS-FNB) in the pre-operative diagnosis of solid pseudopapillaryneoplasms (SPN). This study aimed to evaluate the diagnostic yield of EUS-TA,including endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) andEUS-FNB, in patients with SPN.

METHODS: We performed a retrospective analysis of patientswith EUS-TA for SPN diagnosis in 2 referral centers. The primary outcome wasthe diagnostic yield of EUS-TA compared to the surgical specimen.

RESULTS: Seventy-four patients with SPN of the pancreas wereidentified. Eighteen had a EUS-TA (10 EUS-FNB and 8 EUS-FNA). The median age ofthe patients was 31 years (IQR 21-38), and all patients were women. The mostcommon presenting symptom was abdominal pain. Most of the tumors were in thehead of the pancreas (9/18; 50%). The median tumor size by EUS was 4.5 cm(min-max 2- 15 cm). The most common appearance on EUS was a solid lesion( n  = 8/18, 44.4%). A definitive presurgical cytopathological diagnosis wasobtained in 16/18 patients (88.8%) with EUS-TA. The sensitivity and positivepredictive value of the EUS-TA were 94% each. One patient in the EUS-FNB groupdeveloped mild acute pancreatitis.

CONCLUSION: The diagnostic yield of the EUS-TA in SPNis high. In most cases, the diagnosis was obtained with the first procedure. Nodifferences in the diagnostic yield or AEs between EUS-FNA vs. EUS-FNB needleswere seen.