Needle Selection Strategy for EUS-Guided Tissue Acquisition Using 22-Gauge Needles in Small Pancreatic Solid Lesions

Area of Science:

• Gastroenterology
• Endoscopic Ultrasound
• Oncology

Background:

• Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is crucial for diagnosing pancreatic lesions.
• 22-gauge needles are commonly used for EUS-TA, but the choice between fine-needle aspiration (FNA) and fine-needle biopsy (FNB) for small pancreatic lesions requires evaluation.

Purpose of the Study:

• To compare the diagnostic accuracy and procedural efficiency of 22-gauge fine-needle aspiration (FNA) versus fine-needle biopsy (FNB) for pancreatic solid lesions ≤20 mm.
• To evaluate needle selection for EUS-TA in small pancreatic lesions.

Main Methods:

• Retrospective review of 348 patients undergoing EUS-TA with 22-gauge needles for pancreatic solid lesions ≤20 mm.
• Comparison of overall diagnostic accuracy between FNA (n=193) and FNB (n=155) groups.
• Multivariable logistic regression and propensity score-matched analyses were performed.

Main Results:

• No significant difference in overall diagnostic accuracy between FNA (92.7%) and FNB (95.5%) groups (p=0.27).
• FNB group showed a significantly higher histological yield (92.9% vs. 84.5%, p=0.019) and required fewer needle passes (median 2 vs. 3, p<0.001).
• Needle type was not independently associated with diagnostic accuracy (p=0.24); adverse events were low.

Conclusions:

• For pancreatic solid lesions ≤20 mm, FNB provides superior histological yield and procedural efficiency over FNA.
• Diagnostic accuracy is comparable between FNA and FNB, making FNA adequate for benign-malignant differentiation.
• FNB is preferred when histological architecture or immunohistochemical analysis is necessary.