From the Guidelines
The best way to biopsy a pancreatic mass is through endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy, as it provides a high diagnostic yield, safety, and a potential lower risk of peritoneal seeding, especially in patients with resectable disease. This approach is supported by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology, which recommend EUS-FNA as the preferred method for obtaining a pathologic diagnosis of adenocarcinoma of the pancreas 1. The use of EUS-FNA allows for additional staging information at the time of biopsy and is highly accurate and reliable for determining malignancy.
Some key benefits of EUS-FNA include:
- Increased diagnostic yield compared to CT-guided FNA
- Lower risk of peritoneal seeding
- Ability to provide additional staging information at the time of biopsy
- High accuracy and reliability for determining malignancy
- Minimally invasive procedure with lower complication rates compared to percutaneous approaches
It is essential to note that if a biopsy does not confirm malignancy, at least one repeat biopsy should be performed, with EUS-FNA with or without a core needle biopsy at a high-volume center being the preferred approach 1. A positive biopsy is required before chemotherapy administration, but biopsy proof of malignancy is not required before surgical resection for clearly resectable or borderline resectable disease.
From the Research
Biopsy Methods for Pancreatic Mass
- Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a commonly used method for diagnosing pancreatic lesions 2, 3.
- EUS-FNA has been shown to be highly sensitive and specific for detecting pancreatic masses, especially those smaller than 2-3 cm 2.
- However, EUS-FNA has limitations, including the inability to determine histologic architecture and a small quantitative sample for further immunohistochemical staining 4.
Comparison of EUS-FNA and EUS-FNB
- Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been developed to overcome the limitations of EUS-FNA 4, 5.
- EUS-FNB has been shown to be similar to EUS-FNA in terms of sensitivity, specificity, and accuracy for diagnosing pancreatic masses 5.
- However, EUS-FNB allows for more consistent cell-block evaluation and may be useful in cases where previous EUS-guided sampling was indeterminate 5.
Role of Rapid On-Site Evaluation (ROSE)
- ROSE has been shown to improve the diagnostic yield of EUS-FNA and EUS-FNB 5.
- EUS-FNA with ROSE has been found to have similar sensitivity to EUS-FNB alone, suggesting a reduced need for ROSE as part of the standard algorithm for pancreatic sampling 5.
- However, EUS-FNB with ROSE may still be useful in cases where previous EUS-guided sampling was indeterminate 5.