Endoscopic ultrasound fine-needle aspiration vs fine needle biopsy for pancreatic masses, subepithelial lesions, and lymph nodes

Abstract

Endoscopic ultrasound tissue acquisition, in the form of both fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), is utilized for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA has the potential limitations associated with cytological aspirations, including inability to determine histologic architecture, and perhaps small quantitative sample for further immunohistochemical staining. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. However, it remains unclear which technique should be used and for which lesions. Comparative trials are plagued by heterogeneity at every stage of comparison; including variable needles used, different definitions of endpoints, and therefore limits generalizability. Thus, we present a review of prospective trials, systematic reviews, and meta-analyses on studies examining EUS-FNA vs EUS-FNB. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions, and yield conflicting results in terms of demonstrating superiority of one method. Yet consistent among trials is potential for diagnosis with fewer passes, and larger quantity of sample achieved for next generation sequencing. Pertaining to subepithelial lesions and lymph node biopsy, fewer prospective trials exist, and larger prospective studies are necessary. Yet based on the available literature, we would recommend EUS-FNB for peri-hepatic lymph nodes.