The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions
Abstract
:1. Introduction
2. Diagnostic Ability of EUS-TA for Each Pancreatic Solid Lesion
2.1. Pancreatic Cancer
2.2. Pancreatic Neuroendocrine Neoplasms (PanNENs)
2.3. Solid Pseudopapillary Neoplasms (SPNs)
2.4. Metastatic Tumors to the Pancreas
2.5. Autoimmune Pancreatitis (Mass-Forming Pancreatitis)
2.6. Primary Pancreatic Lymphoma (PPL)
Cytology/Histology | Immunohistochemistry (IHC) | Genetic Abnormalities | |
---|---|---|---|
PDAC | Desmoplasia | KRAS, p53, Dpc4, p16 | KRAS, TP53 SMAD4, CDKN2A |
Acinar cell carcinoma | Acinar structure Glandular structure Cribriform pattern | Trypsin, BCL10 | SMAD4, JAK1, BRAF BRCA2, FAT, CTNNB1, APC |
Anaplastic carcinoma | Pleomorphic type Spindle type Osteoclast-like giant cells | Keratin, CK7/20, Vimentin | KRAS, TP53 |
PanNET | Well-differentiated Mitotic count | Ki-67 labeling index SSTR2A, DAXX, ATRX | DAXX, ATRX |
PanNEC | Poorly differentiated | Ki-67 labeling index Rb, p53 | KRAS, RB1, TP53 |
SPN | Differential diagnosis: PanNET | β-catenin nuclear labeling SOX-11, TFE3 | CTNNB1 |
Metastatic tumors to the pancreas | Similar to the primary tumor | Depending on characteristics of the primary tumor | |
AIP | Lymphocyte infiltration Storiform fibrosis Obliterative phlebitis (Victoria blue staining) | IgG4-positive plasma cells | |
Pancreatic lymphoma | Low sensitivity | CD20, CD79a, CD5, CD10, CD3 Cyclin D1, bcl-2, TdT | Depending on the subtype |
3. How to Improve the Diagnostic Performance of EUS-TA
3.1. Choice of Puncture Needles
3.2. Puncture Methods
3.2.1. Door-Knocking Method, Fanning Technique, and Suction Techniques
3.2.2. Number of Passes
3.2.3. EUS-TA with Contrast Enhanced EUS (CE-EUS)
3.2.4. EUS-Elastography
3.3. Sample Processing Methods
3.3.1. Rapid On-Site Evaluation (ROSE)
3.3.2. Macroscopic On-Site Evaluation (MOSE)
3.3.3. Liquid-Based Cytology (LBC)
3.3.4. IHC, Genetic Analysis
4. EUS-TA for Precision Medicine
4.1. Precision Medicine for PDAC
4.2. NGS Using EUS-FNA/FNB Specimens
5. Adverse Events
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Advantages | Disadvantages | ||
---|---|---|---|
Selection of puncture needles | FNA needles | Relatively easy to puncture | Sometimes insufficient specimen |
FNB needles | Favorable diagnostic ability and tissue acquisition Reduction in the number of punctures | Rarelydifficult to puncture | |
Puncture methods | Puncture Door-knocking method Fanning technique Suction High-negative-pressure method Slow-pull method Wet-suction method | No consensus on the appropriate puncture method | |
Number of punctures | Additional punctures improve the sensitivity | The sensitivity reached a plateau after the 3rd or 4th puncture (Franseen and Fork-tip type: 2nd puncture) | |
Ancillary imaging studies | CE-EUS EUS-elastography | Improvement of sensitivity and sample adequacy | >Dependent on endosonographer’s experience |
On-site evaluation | ROSE MOSE | Reduction in the number of punctures | Time- and human-resource- consuming examination |
Sample processing method | LBC | Collection of a larger number of tumor cells with limited specimens Standardization of the sample processing method | Time- and cost- consuming examination |
IHC Genetic analysis | Particularly useful in cases of inconclusive cytological diagnosis | A sufficient specimen required |
Needle Type | Main Products | Needle Size | Launched Year in Japan | Diagnostic Accuracy Tissue Acquisition | Ease of Puncture |
---|---|---|---|---|---|
EUS-FNA: | Sometimes insufficient Favorable | Relatively easy Rarely difficult | |||
Menghini | Expect (Boston Scientific) | 19, 22, 25G | 2011 | ||
SonoTip Pro Control (MediGlobe) | 19, 22, 25G | 2012 | |||
EUS Sonopsy CY (HAKKO) | 21G | 2013 | |||
Expect Slimline (Boston Scientific) | 19, 22, 25G | 2014 | |||
EZ shot 3 plus (Olympus) | 19, 22, 25G | 2016 | |||
EUS-FNB: | |||||
Reverse-bevel | Echo Tip ProCore (Cook Medical) | 19, 22, 25G | 2012 | ||
Forward-bevel | Echo Tip ProCore (Cook Medical) | 20G | 2016 | ||
Fork-tip | SharkCore (Medtronic) | 19, 22, 25G | 2020 | ||
Franseen | Acquire (Boston Scientific) | 19, 22, 25G | 2016 | ||
Sono Tip Top Gain (Medi-Globe) | 19, 22, 25G | 2020 |
IHC Abnormalities | Genetic Abnormalities | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Author Year | PanNET/ PanNEC | SSTR2A (IHC) | DAXX (IHC) | ATRX (IHC) | Rb (IHC) | p53 (IHC) | DAXX | ATRX | KRAS | RB1 | TP53 |
Yachida 2012 [82] | PanNET | 9.1% (1/11) | 36.4% (4/11) | 0% (0/11) | 0% (0/11) | 0% (0/11) | 0% (0/11) | 0% (0/11) | |||
Marinoni 2014 [83] | PanNET | 25% (23/92) | 18% (20/92) | DAXX or ATRX 48% (12/25) | |||||||
Gleeson 2017 [84] | PanNET | 11.1% (10/90) | 10.0% (9/90) | 3.3% (3/90) | 2.2% (2/90) | 3.3% (3/90) | |||||
Chan 2018 [85] | PanNET | 25% (16/64) | 10.4% (7/64) | ||||||||
Hackeng 2021 [86] | PanNET | DAXX or ATRX 31.1% (208/668) | - | ||||||||
Simbolo 2021 [87] | PanNET | 24.1% (7/29) | 20.7% (6/29) | ||||||||
Hijioka 2017 [88] | PanNET-G3 | 0% (0/21) | 0% (0/21) | ||||||||
Konukiewitz 2017 [89] | PanNET-G3 | 77.8% (7/9) | 33.3% (3/9) | 11.1% (1/9) | 0% (0/9) | 0% (0/9) | 0% (0/9) | ||||
Yachida 2012 [82] | PanNEC | 0% (0/19) | 0% (0/19) | 73.7% (14/19) | 94.7% (18/19) | 28.6% (2/7) | 71.4% (5/7) | 57.1% (4/7) | |||
Hijioka 2017 [88] | PanNEC | 54.5% (24/44) | 48.7% (20/41) | ||||||||
Konukiewitz 2017 [89] | PanNEC | 8.3% (1/12) | 0% (0/11) | 0% (0/11) | 41.7% (5/12) | 75.0% (9/12) | 66.7% (8/12) |
Gene Mutation | Frequency | Author Year | Study Design | Patients | Regimen | Results |
---|---|---|---|---|---|---|
HRD | HRD 15% BRCA 1: 0.9% BRCA 2: 3.5% PALB2: 0.2% ATM: 2.2% ATM: 0.2% | Wattenberg 2020 [90] | Retrospective | gBRCA 1/2 PALB2 PDAC | Platinum- based regimen | gBRCA 1/2, PALB2 Control ORR 58% 21% PFS 10.1 mo 6.9 mo OS 24.6 mo 18.8 mo |
Golan 2019 [92] | Phase 3 | gBRCA PDAC | Olaparib | Olaparib Placebo PFS 7.4 mo 3.8 mo HR 0.53 (95% CI: 0.35–0.82) OS 18.9 mo 18.1 mo HR 0.91 (95% CI: 0.56–1.46) | ||
MSI-H dMMR | 1–2% | Marabelle 2019 [93] | Phase 2 | MSI-H/dMMR PDAC | Pembrolizumab | ORR 18.2% (4/22) Median PFS: 2.1 mo (95% CI: 1.9–3.4) Median OS: 4.0 mo (95% CI: 2.1–9.8) |
Le 2017 [94] | Prospective | dMMR PDAC | Pembrolizumab | ORR 62% (5/8) DCR 75% (6/8) | ||
NTRK gene fusions | less than 1% | Doebele 2020 [97] | Phase 1/2 Pooled analysis of 3 studies | NTRK gene fusions Solid tumors | Entrectinib | ORR 57% DCR 74% Median DOR: 10.4 mo Median PFS: 11.2 mo |
Hong 2020 [98] | Phase 1/2 Pooled analysis of 3 studies | NTRK gene fusions Solid tumors | Larotrectinib | ORR 79% DCR 91% Median DOR: 35.2 mo Median PFS: 28.3 mo | ||
KRAS G12C mutation | unknown | Hong 2020 [100] | Phase 1 | KRAS G12C mutation Solid tumors | Sotorasib | ORR 32.2% DCR 88.1% Median PFS 6.3 mo |
Skoulidis 2021 [99] | Phase 2 | KRAS G12C mutation Lung cancer | Sotorasib | ORR 37.1% DCR 80.6% Median DOR 11.1 mo |
Author Year | Number of Patients | Puncture Needles | Targeted Panel | Requirements for NGS | DNA Amount/ Concentration Extracted | Success Rate/ Adequacy Rate for NGS | Frequency of Genomic Alternations (PDAC) |
---|---|---|---|---|---|---|---|
Young 2013 [72] | PDAC n = 18 AC NOS n = 2 MCC n = 2 PanNEC n = 1 | NA | Custom panel 287 genes | Tumor cells: 20% DNA amount: 50 ng | NA | 100% (23/23) | KRAS 83% CDKN2A 44% |
Kameta 2016 [73] | PDAC n = 27 | NA | Ampliseq Cancer Hotspot Panel v2 50 genes | NA | NA | 100% (27/27) | KRAS 96% TP53 44% SMAD4 11% CKDN2A 11% |
Gleeson 2016 [74] | PDAC IPMC AC n = 47 | NA | Human Comprehensive Cancer GeneRead DNAseq Targeted Panel V2 160 genes | Tumor cells: 20% DNA concentration: 5 ng/μl | Smear cytology: mean 21.0 ng/μL (Range 0–88.7) FFPE: mean 66.9 ng/μL (Range 9.3–164) | 61.7% (29/47) | KRAS 93.1% TP53 72.4% SMAD4 31% GNAS 10.3% |
Elhanafi 2019 [75] | PDAC n = 167 | EUS-FNA/ EUS-FNB 22 G | TruSeq Amplicon Cancer Panel 47 genes | Tumor cells: 10% | NA | 70.1% (117/167) * EUS-FNA: 66.9% (97/145) * EUS-FNB: 90.9% (20/22) * | KRAS 88% TP53 68% SMAD4 16% |
Park 2020 [76] | PDAC n = 190 | EUS-FNA/ EUS-FNB 19,22,25G | Cancer Scan version 1 183 genes | Tumor cells: 30% | NGS success: 1.42 ± 1.57 μg NGS failure: 0.54 ± 1.70 μg | 57.4% (109/190) | KRAS 78.9% TP53 60.6% SMAD4 30.3% CKDN2A 25.7% |
Ishizawa 2020 [77] | PC n = 26 | EUS-FNA/ EUS-FNB 22G | AmpliSeq Comprehensive Cancer Panel 409 genes | NA | mean 171 ng (Range 34–478) | 100% (26/26) | KRAS 92% TP53 50% SMAD4 31% CDKN2A 15% |
Carrara 2021 [79] | PDAC: 33 | EUS-FNB 22G | AmpliSeq Comprehensive Panel v3 161 genes | NA | NA | 97.0% (32/33) | KRAS 94% TP53 78% SMAD4 13% CDKN2A 9% GNAS 9% |
Habib 2021 [80] | PDAC: 56 | NA | Ampliseq Custom Panel 9 genes | DNA concentration: 3.3 ng/μL | NA | 100% (56/56) | KRAS 85.7% TP53 32.1% SMAD4 3.6% CKDN2A 3.6% |
Larson 2018 [102] | PDAC: 74 ACC: 1 AC: 1 | NA | FoundationOne CDx 324 genes | Tumor cells: 20% Specimen surface area: 25 mm2 | NA | EUS-FNA: 42.9% (3/7) ** EUS-FNB: 70.4% (38/54) ** | NA |
Kandel 2021 [103] | PDAC: 37 PanNET: 5 Other malignancies: 3 Benign: 5 | EUS-FNA: 25G EUS-FNB: 19, 22G | FoundationOne CDx 324 genes | Tumor cells: 20–30% Specimen surface area: 25 mm2 | EUS-FNA: mean 3.36 ng/μL EUS-FNB: mean 5.93 ng/μl | EUS-FNA:14% ** (7/50) EUS-FNB: 78% (39/50) | NA |
Predictors | Adverse Events (AEs) |
---|---|
FNA vs. FNB | Comparable |
Needle size | Frequency of AEs (Same for both EUS-FNA and EUS-FNB) 25G < 22G < 19G |
Number of passes | Possibility of increase in pancreatitis |
To-and-fro movement | |
Types of SPLs: PanNET | |
Pancreatic body or tail cancers | Increase in needle tract seedings |
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Tanaka, H.; Matsusaki, S. The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions. Diagnostics 2022, 12, 753. https://doi.org/10.3390/diagnostics12030753
Tanaka H, Matsusaki S. The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions. Diagnostics. 2022; 12(3):753. https://doi.org/10.3390/diagnostics12030753
Chicago/Turabian StyleTanaka, Hiroki, and Shimpei Matsusaki. 2022. "The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions" Diagnostics 12, no. 3: 753. https://doi.org/10.3390/diagnostics12030753