Endoscopic ultrasound–guided fine-needle biopsy as a novel approach for risk stratification of pancreatic cystic lesions

Background and Aims

Unlike fine-needle biopsy (FNB), fine-needle aspiration (FNA) is limited by its inability to preserve histopathology. We compared the diagnostic yield of endoscopic ultrasound (EUS)–guided FNA and EUS-FNB for pancreatic cystic lesions (PCLs), hypothesizing that EUS-FNB would frequently provide a tissue diagnosis.

Methods

A single-center retrospective cohort study was conducted from 2022 to 2023 on patients with PCLs who underwent either EUS-FNA or EUS-FNB. We compared cyst characteristics and pathology reports to assess diagnostic yield. The relative risk (RR) was calculated to compare FNB’s probability of identifying intraductal papillary mucinous neoplasm (IPMN) grade compared with FNA.

Results

A total of 130 PCLs were identified (FNA: n = 34; FNB: n = 96). Patients had a mean age of 68 ± 12 years, and 49% were women. Sex, age, cyst size, location, and presence of pancreatic ductal dilation did not differ significantly between FNA and FNB groups. FNB showed a significantly higher diagnostic yield compared with FNA (81% vs 62%; P = .02), with better performance in identifying an IPMN grade compared with FNA (RR = 1.92; P = .013).

Conclusions

Our results reflect one of the first studies, to our knowledge, to consider the diagnostic role of FNB in evaluating PCLs. These preliminary results suggest that FNB may have a potential for high diagnostic performance in PCLs and warrant further exploration using a larger cohort and randomized controlled trials.