World Congress of Gastroenterology

WCOG 2019


 
Endoscopic Ultrasound Fine-Needle Biopsy and Macroscopic On-Site Evaluation (MOSE) with Combined Cytological and Histological Analysis May Overcome the Need of Rapid On-Site evaluation (ROSE): a Prospective Study
PEDRO COSTA-MOREIRA 1 FILIPE VILAS-BOAS 1 JOANA CARVãO 2 RUI GASPAR 1 VíTOR PEREIRA 2 ARMANDO PEIXOTO 1 MARCO SILVA 1 PEDRO MOUTINHO-RIBEIRO 1 SUSANA LOPES 1 GUILHERME MACEDO 1

1- WGO PORTO GASTROENTEROLOGY AND HEPATOLOGY TRAINING CENTER, PORTUGAL
2- HOSPITAL CENTRAL DO FUNCHAL, PORTUGAL
 
Background/Aims:

Fine-needle biopsy (FNB) is an adjunct or alternative to fine-needle aspiration (FNA) in endoscopic ultrasound (EUS) tissue acquisition. The ability EUS-FNB to provide a macroscopic visible core (MVC) allows the evaluation of the biopsy specimen by the endoscopist (Macroscopic On-Site Evaluation - MOSE).  

We aimed to assess the accuracy of simultaneous cytological/histological analysis after MOSE in EUS-FNB, as well as to compare the diagnostic yield of this new method with the use of ROSE in EUS-FNA. 

Materials and Methods:

Prospective study with a consecutive sample of patients who underwent EUS-FNB for solid lesions of the upper gastrointestinal tract from January 2018 to December 2018. After EUS-FNB, the MVC was used for histologic evaluation, and the residual sample was used in a smear for cytologic assessment. Control cases submitted to ROSE were obtained from the same center, using a historical cohort of EUS-FNA of solid pancreatic lesions. 

Results:

We included 52 cases (mean age 61.1± 6.5 years, 58% males) with solid pancreatic lesions (51.9%), lymph nodes (19.2%) and subepithelial lesions of the digestive tract (28.8%). Lesions submitted to EUS-FNB had a mean diameter of 37.1±18.0mm.

For EUS-FNB we used mostly "Franseen" (65.4%) and "Fork-tip" (25.0%) needles, with a median number of 3 (IQR 2-3) passes. 

The obtained MCV was satisfactory for histological evaluation in 82.7% of the cases. The combined cytology-histological analysis had a diagnostic yield of 86.5%. MOSE technique followed by combined cytology-histological analysis showed a sensitivity of 93.3%, specificity of 85.7% and a positive predictive value of 97.7% to obtain an adequate sample. 

When compared with cases submitted to EUS-FNA+ROSE (61 lesions, with a mean diameter of 37.6±35mm) the combined cytology-histological revealed a diagnostic accuracy in a similar proportion (MOSE: 86.5%, ROSE: 83.6%, p=0.66). 

Conclusion:

The combined cytology-histological analysis is a new and easy-to-perform tool that showed an overall diagnostic yield similar to ROSE. 

Keywords:

Endoscopic Ultrasound; Fine-Needle Biopsy; Citology; Histology