REVIEW   

Minerva Medica 2017 December;108(6):547-53

DOI: 10.23736/S0026-4806.17.05327-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Endoscopic ultrasound core needle for diagnosing of solid pancreatic lesions: is rapid on-site evaluation really necessary?

Monica ARENA ¹, Leonardo H. EUSEBI ², Rinaldo PELLICANO ³, Maria A. PALAMARA ¹, Giuseppe IABICHINO ¹, Pierluigi CONSOLO ⁴, Sharmila FAGOONEE ⁵, Enrico OPOCHER ⁶, Matteo BARABINO ⁶, Carmelo LUIGIANO ¹ ✉

¹ Unit of Digestive Endoscopy, San Paolo Hospital, Milan, Italy; ² Unit of Gastroenterology, S. Orsola-Malpighi University Hospital, Bologna, Italy; ³ Department of Gastro-Hepatology, Molinette Hospital, Turin, Italy; ⁴ Department of Medicine and Pharmacology, G. Martino Hospital, University of Messina, Messina, Italy; ⁵ Institute for Biostructures and Bioimages CNR c/o Molecular Biotechnology Center, University of Turin, Turin, Italy; ⁶ Unit of Hepatobilyopancreatic and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy

INTRODUCTION: Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) has a crucial role in the diagnosis of solid pancreatic lesions and rapid on-site evaluation (ROSE) can increase its diagnostic yield. Rapid on-site evaluation is not always available and after EUS-FNA provides a cytology specimen with scant cellularity. Fine needle biopsy (FNB) specimens containing core tissue may theoretically overcome the limitations of EUS-FNA sampling. It could be hypothesized that EUS-FNB without ROSE could achieve the same adequacy and accuracy of EUS-FNB with ROSE. The aim of this review is to evaluate the evidence on the role of ROSE in the setting of EUS-guided tissue acquisition with core needles in patients with solid pancreatic lesions.
EVIDENCE ACQUISITION: All relevant articles were extracted up to February 2017 based on the results of searches in PubMed, Scopus and Google Scholar.
EVIDENCE SYNTHESIS: A total of 21 pertinent articles were finally included. Among the included studies, 11 were performed without ROSE, 8 with ROSE, and 2 were performed both with and without ROSE. In the ROSE group we found a sensitivity, specificity, overall diagnostic adequacy and overall diagnostic accuracy of 96%, 100%, 86.5%, 85.5%, respectively, while in the no-ROSE group 86.6%, 100%, 89.5%, 86.1% were found, respectively. Mild pancreatitis (mean rates, 3.43%) and abdominal pain (mean rates, 3.6%) were reported as most frequent adverse events.
CONCLUSIONS: Endoscopic ultrasound guided-FNB without ROSE offers similar results in terms of adequacy and accuracy as in the presence of an on-site cytopathologist.

KEY WORDS: Biopsy, fine-needle - Pancreas - Biopsy, large-core needle