EUS-guided fine-needle biopsy sampling of solid pancreatic masses with and without rapid onsite evaluation for...

Although EUS-guided fine-needle biopsy sampling (EUS-FNB) of solid pancreatic lesions with or without the use of rapid onsite evaluation (ROSE) provides a high diagnostic yield, the utility of ROSE for commercial genomic analysis is unclear.

A multicenter retrospective review was conducted of consecutive patients where genomic analysis was requested from EUS-FNB of solid pancreatic lesions, performed with 22-gauge fine-needle biopsy (FNB) needles. Data were collected at 2 academic centers, one that routinely uses ROSE to assess adequacy for all EUS-FNB cases (University of California San Francisco, n = 44) and one that does not use ROSE (Washington University, n = 186).

The cohort consisted of 230 patients (mean age, 67.3 ± 9.8 years; 52.6% women). There were no significant differences between patient and tumor characteristics or locations in the 2 groups. Adverse events were uncommon and similar between the groups (1.6% vs 0%). Adequacy for genomic evaluation was high and similar between those cases without and with ROSE (159/186 [85.5%] vs 39/44 [88.6%], P = .8). Genomic analysis resulted in potentially actionable mutations in a similar number of cases without and with ROSE (18.3% vs 15.9%, P = .82). However, compared with FNB sampling without ROSE, FNB sampling with ROSE required more than double the procedure time (mean, 21.1 ± 10 minutes vs 49.7 ± 20.6 minutes; P < .001) and a significantly higher number of median needle passes (3 [IQR, 2-3] vs 4 [IQR, 3-4], P < .001).

Although EUS-FNB with ROSE did not have a significantly different adequacy for commercial genomic analysis compared with EUS-FNB without ROSE, it required significantly more procedure time and needle passes.