Shafi Saba, Frankel Wendy L, Li Zaibo, Jones Dan, Krishna Somashekar G, Esnakula Ashwini K, Yearsley Martha, Sun Shaoli, Lujan Giovanni, Vazzano Jennifer, Weldemichael Wegahta, Lee Peter, Shah Hamza, Burlen Jordan, Papachristou George, Chen Wei
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Am J Clin Pathol. 2025 May 25. doi: 10.1093/ajcp/aqaf050.
Endoscopic ultrasound (EUS)-guided, fine-needle core biopsy (FNB), and through-the-needle microforceps biopsy (TTNB) are latest tools for evaluating pancreatic lesions. We aim to provide subspecialty surgical pathologists' experience with EUS-FNB/TTNB in diagnosing pancreatic lesions at a large academic center.
A 3-year review identified 101 EUS pancreatic specimens submitted for surgical pathology: 87 biopsy specimens (FNB = 58, TTNB = 29) and 14 fine-needle aspirations (FNAs). Diagnoses were compared with cytology and resection specimens when available.
Of the 101 cases, 10 had previous EUS-FNA cytology with inconclusive diagnoses. Rebiopsy with EUS-FNB/TTNB provided definitive diagnoses in 9 cases. Thirty-five cases (18 cystic and 17 solid lesions) had concurrent surgical pathology and cytology specimens. The diagnostic yield of EUS-FNB/TTNB biopsy specimens (69%) was significantly higher than that of cytology specimens (26%, P = .0017), as was the diagnostic accuracy (P = .0012). This diagnostic advantage was statistically significant in cystic lesions (FNB/TTNB [83.3%] vs cytology [16.7%] for achieving a specific diagnosis, P = .0002) but not in solid lesions (61.5% vs 46.2%, P = .6951). Only in 1 case did cytology (adenocarcinoma) provide a more definitive diagnosis than surgical pathology (high-grade dysplasia cannot exclude adenocarcinoma).
The EUS-FNB/TTNB methods complement EUS-FNA cytology in diagnosing pancreatic lesions, and they often outperforms concurrent cytology specimens, particularly in cystic lesions.
内镜超声（EUS）引导下的细针芯活检（FNB）和经针微钳活检（TTNB）是评估胰腺病变的最新工具。我们旨在分享大型学术中心的专科手术病理学家在使用EUS-FNB/TTNB诊断胰腺病变方面的经验。
对3年期间提交给手术病理科的101份EUS胰腺标本进行回顾性分析：87份活检标本（FNB = 58份，TTNB = 29份）和14份细针穿刺抽吸标本（FNA）。如有细胞学和切除标本，将诊断结果与之进行比较。
在101例病例中，10例曾接受EUS-FNA细胞学检查，诊断结果不明确。再次使用EUS-FNB/TTNB活检确诊了9例。35例（18例囊性病变和17例实性病变）同时有手术病理和细胞学标本。EUS-FNB/TTNB活检标本的诊断阳性率（69%）显著高于细胞学标本（26%，P = 0.0017），诊断准确性也是如此（P = 0.0012）。这种诊断优势在囊性病变中具有统计学意义（FNB/TTNB达到特异性诊断的比例为[83.3%]，而细胞学为[16.7%]，P = 0.0002），但在实性病变中无统计学意义（61.5%对46.2%，P = 0.6951）。只有1例病例中，细胞学（腺癌）诊断比手术病理更明确（高级别发育异常不能排除腺癌）。
EUS-FNB/TTNB方法在诊断胰腺病变方面补充了EUS-FNA细胞学检查，并且通常优于同时期的细胞学标本，尤其是在囊性病变中。
