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

DOI: 10.23736/S0026-4806.17.05327-7


lingua: Inglese

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

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