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

As cytological aspirates from endoscopic-ultrasound-guided fine needle aspiration (EUS-FNA) has limited diagnostic sensitivity and are suboptimal for molecular profiling and morphological characterisation of certain neoplasms, a fine needle biopsy (FNB) with three-pronged (Franseen geometry) cutting edge has been developed to procure histology. In a randomised trial of 46 patients with pancreatic masses, procurement of histological core tissue as evidenced by total tissue and tumour areas was significantly higher for 22G FNB than FNA needle. Also, retention of tissue architecture and presence of desmoplastic fibrosis, which are critical for ancillary testing and molecular profiling, respectively, were significantly higher for FNB. Given the poor outcomes of traditional chemotherapy, there is increased focus on molecular profiling so that pancreatic cancer treatment can be personalised. Pancreatic tissue with architecture containing both tumour cells and desmoplastic stroma is pivotal for molecular analysis. Although EUS-FNA is diagnostically accurate, the cytological aspirate is suboptimal for DNA sequencing.1–3 Therefore, clinical trials evaluating personalised treatment in pancreatic cancer prefer tissue procurement via percutaneous or surgical biopsies over EUS-FNA.4 Recently, a three-plane symmetric needle with Franseen geometry has been developed for performing EUS-guided FNB.5 The large crown-tip with three cutting edges and long insertion length were postulated to facilitate histological tissue procurement (figure 1A). We conducted a randomised trial comparing tissue acquisition between the 22-gauge (G) Franseen biopsy (Acquire, Boston Scientific) and 22G standard bevel FNA (Expect, Boston Scientific) (figure 1B) needles in patients undergoing EUS-guided sampling of pancreatic masses. 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). EUS-guided sampling was performed using both needle types, the 22G FNB and 22G FNA needles, with randomisation of the order in which the …