Comparison of Standard Fine Needle Aspiration versus Fine Needle Biopsy for Endoscopic Ultrasound Guided Sampling of Solid Lesions

Abstract Background Endoscopic ultrasound (EUS) -guided tissue acquisition is the standard of care for the diagnosis of solid pancreatic lesions. Traditionally, sampling is performed through fine-needle aspiration and the diagnosis is made through cytology. The challenge in solid pancreatic lesions is that they are often fibrotic, with significant necrosis limiting the cellularity of samples obtained via fine-needle aspiration. Aim of the Work The aim of the current study was to compare fine needle aspiration versus fineneedle biopsy for the diagnostic yield of malignancy. - The secondary objectives are to compare fine needle aspiration versus fine-needle biopsy for: 1) The overall diagnostic yield from solid lesions. 2) The diagnostic yield from pancreatic and nonpancreatic solid lesions. 3) The crossover diagnostic yield. 4) The sample quality obtained by either the slow-pull or suction approaches, respectively. Patients and Methods This is a cross-sectional study, included 92 patients (52 male and 40 female), age ranges from (18-80 y); with indeterminate pancreatic lesions and gastric lesions selected randomly from April 2021 till March 2022 from the outpatient clinics of Theodor Bilharz Research Institute. Results The most common lesion founded in fine needle aspiration group by CT or MRI was Pancreatic soft tissue mass in 86.9% and in the fine needle Biopsy group was also Pancreatic soft tissue mass in 80.4% with a statistically difference in between. The most common lesion founded in FNA group by EUS was Pancreatic soft tissue mass in 73.9% and in the FNB group was also Pancreatic soft tissue mass in 89.1% with a statistically difference in between. The cytologic examination shows 60.8% of FNA group and 69.5% of FNB group are malignant lesions. the majority of the lesions were Pancreatic adenocarcinoma in the FNA group was 47.8% and in FNB group was 56.5%. The sensitivity was 97.8% versus 92.5%, specificity 96.4% versus 92.8%, PPV 95% versus 90%, NPV 100% versus 96%, and accuracy 97.2% versus 92.7% for FNA and FNB, respectively Conclusion EUS-FNA is superior to EUS-FNB in sampling pancreatic masses. EUS-guided FNA and FNB are safe, appropriate procedures that have comparable diagnostic accuracy for solid lesions within the gastrointestinal tract. The 22-G FNB needles are easy handling in anatomically challenging locations and required fewer needle passes to reach diagnosis.