EUS-guided fine-needle biopsy versus fine-needle aspiration in the diagnosis of subepithelial lesions: a large multicenter study

ABSTRACT Background and Aims Although conventional endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has previously been considered first-line for sampling subepithelial lesions (SELs), variable accuracy has resulted in increased use of fine-needle biopsy (FNB) to improve diagnostic yield. The primary aim of this study was to compare FNA versus FNB for diagnosis of SEL. Methods This was a multicenter, retrospective study to evaluate the outcomes of EUS-FNA and EUS-FNB of SELs over a 3-year period. Demographics, lesion characteristics, sensitivity, specificity, accuracy, number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block accuracy, as well as adverse events were analyzed. Subgroup analyses were performed comparing FNA versus FNB by location as well as diagnostic yield with or without ROSE. Multivariable logistic regression was also performed. Results A total of 229 patients with SELs (n=115 FNA and n=114 FNB) underwent EUS-guided sampling. Mean age was 60.86±12.84 years. Most lesions were gastric in location (75.55%) and from the fourth layer (71.18%). Cell-block for FNB required fewer passes to achieve conclusive diagnosis (2.94±1.09 versus 3.55±1.55; P=0.003). Number of passes were not different for ROSE adequacy (P=0.167). Immunohistochemistry (IHC) was more able to be successfully performed in more FNB samples (69.30% versus 40.00%; P 0.05). Multivariate analysis showed no predictors associated with accuracy. One minor adverse event was reported in the FNA group. Conclusions EUS-FNB was superior to EUS-FNA in the diagnosis of SELs. EUS-FNB was also superior to EUS-FNA alone and EUS-FNA+ROSE. These results suggest EUS-FNB should be considered a first-line modality and may suggest a reduced role for ROSE in the diagnosis of SELs. However, a large randomized controlled trial is required to confirm our findings.