Factors associated with the diagnostic yield of EUS-FNA/B in pancreatic lesions: the experience from two high-volume centers

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Aims EUS-FNA and especially EUS-FNB have become the standard of care for the diagnosis of pancreatic lesions, and several factors, including lesion size, location, needle type, number of passes, and operator expertise are associated with its diagnostic accuracy. The aim of this study is to evaluate factors that are associated with the diagnostic accuracy of EUS-FNA/B in two high-volume centers in Greece. Methods Data from consecutive patients with pancreatic lesions who underwent EUS-FNA/B from 2017 to 2024 were collected retrospectively. Parameters considered were patient demographics, needle type, needle diameter, needle passes, the location of the lesion, the lesion diameter, and the final cytology results. The associations between mass location, mass size, needle type, number of needle passes and cytology result were analyzed. Results A total of 547 EUS-FNA/B were performed in 524 consecutive patients, 272 (52%) males and 252 (48%) females, with a median age of 69 years (range: 24–91). The median lesion diameter was 33 mm (range: 3 -90). Eleven (2%) EUS-FNA/Bs were carried out using a 20-gauge needle and 480 (87,7%) EUS-FNA/Bs were carried out using a 22- gauge needle. Also, 365(66,7%) procedures were performed using a fine-needle biopsy (FNB). The overall diagnostic accuracy was 479/524 (91,4%). Logistic regression analysis showed that mass location on the head of the pancreas (OR=2.27, 95% CI: 1.04–4.22, p=0.009), size greater than 25 mm (OR=7.35, 95% CI: 1.63–33.57, p=0.05) and two or more needle passes (OR=7.84, 95% CI: 1.95–31.38, p=0.003) were statistically significantly correlated with a higher diagnostic accuracy. An association was found between diagnostic accuracy and use of an EUS-FNB needle, but it did not reach statistical significance (OR=3.08, 95% CI: 1.51–19.8, p=0.06). Conclusions The results of this study suggest that 2 or more needle passes, lesions greater than 25 mm and lesions in the head of the pancreas are associated with a higher diagnostic accuracy of EUS-FNA/B in two high- volume centers. Use of an FNB needle also showed a trend towards a higher diagnostic accuracy, which however did not achieve statistical significance. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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