Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions

Backgrounds:Percutaneous ultrasound(US)and endoscopic ultrasound(EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases.Studies comparing the diagnostic performance of US-and EUS-guided pancreatic biopsies are lacking.This study aimed to evaluate and compare the diagnostic yields of US-and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies.Methods:Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center,275 underwent EUS-guided fine needle aspiration(EUS-FNA),and 799 underwent US-guided core needle biopsy(US-CNB/FNA).The outcomes were inconclusive pathological biopsy,diagnostic accuracy and the need for repeat biopsy.All of the included factors and diagnostic performances of both USCNB/FNA and EUS-FNA were compared,and the independent predictors for the study outcomes were identified.Results:The diagnostic accuracy was 89.8%for EUS-FNA and 95.2%for US-CNB/FNA(P=0.001).Biopsy under EUS guidance[odds ratio(OR)=1.808,95%confidence interval(CI):1.083-3.019;P=0.024],lesion size<2 cm(OR=2.069,95%CI:1.145-3.737;P=0.016),hypoechoic appearance(OR=0.274,95%CI:0.097-0.775;P=0.015)and non-pancreatic ductal adenocarcinoma carcinoma(PDAC)diagnosis(OR=2.637,95%CI:1.563-4.449;P<0.001)were identified as factors associated with inconclusive pathological biopsy.Hypoechoic appearance(OR=0.236,95%CI:0.064-0.869;P=0.030),lesions in the uncinate process of the pancreas(OR=3.506,95%CI:1.831-6.713;P<0.001)and non-PDAC diagnosis(OR=2.622,95%CI:1.278-5.377;P=0.009)were independent predictors for repeat biopsy.Biopsy under EUS guidance(OR=2.024,95%CI:1.195-3.429;P=0.009),lesions in the uncinate process of the pancreas(OR=1.776,95%CI:1.014-3.108;P=0.044)and hypoechoic appearance(OR=0.127,95%CI:0.047-0.347;P<0.001)were associated with diagnostic accuracy.Conclusions:In conclusion,both percutaneous US-and EUS-guided biopsies of solid pancreatic lesions are safe and effective;though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA.A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.