EUS-FNA vs EUS-FNB for Pancreatic Lesions: Which Needle When to Use?

The aim of this review is to present recent evidence on the different needle designs used for endoscopic ultrasound–guided tissue acquisition and further to discuss adequate use of specific needles in patients with pancreatic lesions. Several high-quality studies have recently been published, demonstrating superiority of tissue core needles compared to aspiration needles. Only a few studies have directly compared different core needles, reporting primacy of crown cut designs over side-bevel needles in terms of histology and microcores. As for cystic lesions, novel advancements include a through-the-needle microbiopsy forceps and genetic markers in cyst fluid, both of which have shown promising results. Fine needle biopsy needles procure more histologic-grade tissue compared to aspiration needles and may be preferable in the case of solid pancreatic lesions in an era of precision medicine. However, if the aim of the biopsy procedure is to solely confirm malignancy, FNA needles remain a viable choice.