P0835 - The Diagnostic Outcomes of Endoscopic Ultrasound-Guided Fine Needle Aspiration vs Fine Needle Biopsy for Pancreatic Cystic Lesions

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Ghazal Hashemipour Moussavi, BS (she/her/hers)

University of South Florida Morsani College of Medicine
Tampa, FL

Ghazal Hashemipour Moussavi, BS¹, Maria F.. Gomez, MPH², Jennifer Permuth, PhD, MS², Aamir Dam, MD², Anjuli K.. Luthra, MD², Luis R.. Pena, MD, FACG², Mark Friedman, MD², Jason Fleming, MD², Barbara Centeno, MD², Shaffer R. S.. Mok, MD²
¹University of South Florida Morsani College of Medicine, Tampa, FL; ²Moffitt Cancer Center, Tampa, FL

Introduction: The incidental detection of pancreatic cystic lesions (PCLs) has increased, warranting further morphological characterization and risk stratification to properly guide management. Namely, proper identification and risk stratification of PCLs avoids unnecessary pancreatic surgery, which may carry high morbidity. In this study, we compared the diagnostic yield from endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic cystic lesions. We predicted that FNB would more often yield a morphologic cyst classification than FNA.

Methods: A single-center, retrospective cohort study was conducted at our tertiary-care center from 2022-2023 on patients with PCLs who underwent evaluation with either EUS-FNA or EUS-FNB. Cyst location, characteristics, pathology, and cytology reports were compared to assess the diagnostic yield of the two techniques for cystic lesions. Diagnostic subcategories were grouped into either high-risk [High-grade intraductal papillary mucinous neoplasm (IPMN), neuroendocrine tumor (NET), and other cancer] (n=21) or low-risk (other) (n=78) and compared with patients without a diagnosis (n=31). Risk ratios (RR) were calculated to compare the probability of FNB of diagnosing a high-risk and low-risk diagnosis.

Results: A total of 130 PCLs were identified (FNA, n= 34; FNB, n= 96). The mean patient age was 68±12 years old and 49% were women. The sex, age, cyst size, location, and presence of pancreatic ductal dilation were not significantly different between FNA and FNB groups. The diagnostic yield was significantly higher in FNB than in FNA (81% vs 62%, p=0.02), with FNB performing significantly better in identifying cyst grade (p=0.05). In addition, FNB had a RR of 1.64 (95% CI: 1.07-2.50), p-value= 0.005, for predicting a low-risk diagnosis, and a RR of 0.98 (95% CI: 0.50-1.90), p-value = 0.95, for predicting a high-risk diagnosis compared with FNA.

Discussion: Our results reflect the first study, to our knowledge, to evaluate the diagnostic advantage of FNB to obtain histological architecture in cystic lesions. These preliminary results suggest that FNB may help provide more diagnostically useful information for cyst grade and low-risk diagnosis than the standard FNA technique and warrant further exploration using a larger cohort to address limitations.

Characteristic	Overall, N = 130¹	EUS Type		p-value²
Characteristic	Overall, N = 130¹	FNA¹	FNB¹	p-value²
Diagnostic yield	99 (76%)	21 (62%)	78 (81%)	0.022
Intraductal papillary mucinous neoplasm	59 (45%)	14 (41%)	45 (47%)	0.6
Neuroendocrine tumor	4 (3.1%)	1 (2.9%)	3 (3.1%)	>0.9
Lymphoepithelial cyst	1 (0.8%)	0 (0%)	1 (1.0%)	>0.9
Cancer	8 (6.2%)	4 (12%)	4 (4.2%)	0.2
Metastatic cancer	3 (2.3%)	1 (2.9%)	2 (2.1%)	>0.9
Inflammatory process (pancreatitis, pseudocyst, or abscess)	9 (6.9%)	0 (0%)	9 (9.4%)	0.11
Serous cystadenoma	15 (12%)	1 (2.9%)	14 (15%)	0.058
Grade				0.050
High grade dysplasia	7 (14%)	3 (43%)	4 (9.5%)
Low grade dysplasia	42 (86%)	4 (57%)	38 (90%)
Sample not adequate	7 (5.4%)	3 (8.8%)	4 (4.2%)	0.4
Non-malignant sample	1 (0.8%)	1 (2.9%)	0 (0%)	0.3
Inconclusive features	23 (18%)	9 (26%)	14 (15%)	0.12
¹ n (%)
² Pearson's Chi-squared test; Fisher's exact test

Table: Diagnostic performance of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic cystic lesions.

Disclosures:

Ghazal Hashemipour Moussavi indicated no relevant financial relationships.

Maria Gomez indicated no relevant financial relationships.

Jennifer Permuth indicated no relevant financial relationships.

Aamir Dam indicated no relevant financial relationships.

Anjuli Luthra: Boston Scientific – Consultant.

Luis Pena indicated no relevant financial relationships.

Mark Friedman indicated no relevant financial relationships.

Jason Fleming indicated no relevant financial relationships.

Barbara Centeno indicated no relevant financial relationships.

Shaffer Mok: Conmed – Consultant. Steris – Consultant.

Ghazal Hashemipour Moussavi, BS¹, Maria F.. Gomez, MPH², Jennifer Permuth, PhD, MS², Aamir Dam, MD², Anjuli K.. Luthra, MD², Luis R.. Pena, MD, FACG², Mark Friedman, MD², Jason Fleming, MD², Barbara Centeno, MD², Shaffer R. S.. Mok, MD². P0835 - The Diagnostic Outcomes of Endoscopic Ultrasound-Guided Fine Needle Aspiration vs Fine Needle Biopsy for Pancreatic Cystic Lesions, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.