Impact of rapid on-site evaluation in endoscopic ultrasound-guided tissue acquisition for resectable pancreatic body and tail cancer

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BACKGROUND Needle tract seeding is a potential complication of endoscopic ultrasound-guided tissue acquisition (EUS-TA), particularly in resectable pancreatic body and tail cancer. As the transgastric needle tract is generally not resected, reducing the number of punctures may be clinically important. We hypothesized that rapid on-site evaluation (ROSE) may help minimize the number of punctures while preserving diagnostic accuracy. AIM To investigate whether ROSE-guided EUS-TA is associated with a low number of punctures while preserving diagnostic accuracy in this setting. METHODS This multicenter retrospective study included 94 patients with resectable pancreatic body or tail cancer who underwent EUS-TA with ROSE at three tertiary centers from April 2020 to September 2024. ROSE assessed malignancy for each puncture in real time. The primary outcome was the number of punctures. Cytologic diagnostic performance, per-pass ROSE concordance, positive predictive value, and negative predictive value were evaluated. Factors associated with first-pass diagnostic discrepancy were analyzed using logistic regression. RESULTS A total of 94 patients were included. The mean number of punctures was 1.55 ± 0.80. Overall cytologic diagnostic accuracy was 96.8% on a per-patient basis. For per-pass specimens, concordance between ROSE and the corresponding final cytologic diagnosis was 86.0% (111/129); concordance was 97.8% (90/92) when ROSE indicated malignancy and 56.8% (21/37) when ROSE indicated no malignancy. Use of fine-needle biopsy needles was independently associated with a lower risk of diagnostic discrepancy. CONCLUSION ROSE-guided EUS-TA showed a low mean number of punctures and high diagnostic accuracy in resectable pancreatic body and tail cancer. Controlled studies are needed to determine whether ROSE reduces punctures.

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