Factors Influencing the Diagnostic Performance of Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy after the First Inconclusive Diagnosis of Pancreatic Solid Lesions

ABSTRACT

Background/Aims@#Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is essential in diagnosing solid pancreatic lesions (SPLs), but without rapid on-site evaluation (ROSE), a repeat EUS-FNA/B is crucial for clarifying an inconclusive diagnosis. We aimed to evaluate factors associated with improved diagnostic performance of repeat EUS-FNA/B for initially inconclusive SPL diagnoses without ROSE. @*Methods@#Of 5,894 patients subjected to EUS-FNA/B, 237 (4.0%) with an initially inconclusive diagnosis of SPLs were retrospectively enrolled from five tertiary medical centers between January 2016 and June 2021. Diagnostic performance and procedural factors of EUS-FNA/B were analyzed. @*Results@#The diagnostic accuracies of first and repeat EUS-FNA/B were 96.2% and 67.6%, respectively. Of 237 patients with an inconclusive diagnosis from initial EUS-FNA/B, 150were pathologically diagnosed after repeat EUS-FNA/B. In multivariate analysis of repeat EUS-FNA/B, tumor location (body/tail vs head odds ratio [OR], 3.74; 95% confidence inter-val [CI], 1.48 to 9.46), number of needle passes (≥4 vs ≤3 OR, 4.80; 95% CI, 1.44 to 15.99),needle type (FNB vs FNA OR, 3.26; 95% CI, 1.44 to 7.36), needle size (22 gauge vs 19/20 gauge OR, 2.35; 95% CI, 1.19 to 4.62), and suction method (suction vs others OR, 5.19;95% CI, 1.30 to 20.75) were associated with a significantly improved diagnostic performance. @*Conclusions@#Repeat EUS-FNA/B is essential for patients with an inconclusive EUS-FNA/B without ROSE. To improve the diagnostic performance of repeated EUS-FNA/B, it is recom-mended that 22-gauge FNB needles, ≥4 needle passes, and suction methods are used.