EUS-guided fine needle biopsy of pancreatic masses can yield true histology

Ji Young Bang, Shantel Hebert-Magee, Udayakumar Navaneethan, Muhammad K Hasan, Robert Hawes, Shyam Varadarajulu, Ji Young Bang, Shantel Hebert-Magee, Udayakumar Navaneethan, Muhammad K Hasan, Robert Hawes, Shyam Varadarajulu

No abstract available

Keywords: endoscopic ultrasonography; pancreatic cancer.

Conflict of interest statement

Competing interests: SV: consultant for olympusm medical systems corporation and Boston scientific corporation. RH: consultant for olympus medical systems corporation and boston scientific corporation.

Figures

Figure 1

The 22G Franseen design with a crown-shaped needle tip revealing the three symmetrical planes for histological core tissue acquisition (A). The standard bevel needle used at fine needle aspiration for procurement of cytological aspirates (B).

Figure 2

Flow diagram of patients recruited for participation in the randomised trial. FNA, fine needle aspiration; FNB, fine needle biopsy; EUS, endoscopic-ultrasound.

Figure 3

Rapid onsite evaluation of a pancreatic head mass biopsied using the Franseen needle reveals a cellular specimen comprising malignant cells, fibrosis and benign reactive ductal epithelium (A; Diff-Quik staining, 200×). The corresponding aspirate from a standard FNA needle reveals scattered malignant cells and with minimal fibrosis (B; Diff-Quik staining, 100×). H&E staining of pancreatic adenocarcinoma (100×) procured with the Franseen needle. Cores of exuberant dense desmoplastic fibrosis are seen entrapping malignant ductal epithelium and scattered benign residual acini on sections from the cell block (C). The corresponding image of a specimen from an FNA needle reveals minimal tumour cells and lack of any desmoplastic fibrosis (D). Digital image analysis reveals dense desmoplastic fibrosis (highlighted yellow) surrounding malignant (highlighted blue) ductal groups and foci of residual benign acini (E). The corresponding image of a specimen from an FNA needle reveals fewer tumour cells, lack of any significant architecture and a minute fragment of fibrosis (F). FNA, fine needle aspiration.