Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. EUS-TA
2.3. Material Preparation and Macroscopic Evaluation
2.4. Pathologist Work-Up
2.5. Statistical Analysis
3. Results
3.1. Study Population
3.2. Sample Adequacy
3.3. Adequacy Score 2 or 3
3.4. Tumor Fibrosis
3.5. Diagnostic Performance
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Characteristic | Total (No. 407) |
---|---|
Demographic | |
Gender (male), no. (%) | 240 (59.0%) |
Age (years), median [IQR] | 70 [63–77] |
Study period 2007–2014 | 181 (44.5%) |
Study period 2015–2020 | 226 (55.5%) |
Pancreatic tumor | |
Size (mm), median [IQR] | 31 [24–40] |
Head, no. (%) | 255 (62.7%) |
Uncinate process, no. (%) | 32 (7.9%) |
Neck, no. (%) | 32 (7.9%) |
Body, no. (%) | 52 (12.8%) |
Tail, no. (%) | 36 (8.8%) |
Needle design | |
FNA-needle, no. (%) | 316 (77.6%) |
FNB-needle, no. (%) | 91 (22.4%) |
1st generation FNB-needle, no. | 23 |
2nd generation FNB-needle, no. | 68 |
Needle size | |
19-gauge needle, no. (%) | 5 (1.2%) |
20-gauge needle, no. (%) | 63 (15.5%) |
22-gauge needle, no. (%) | 191 (46.9%) |
25-gauge needle, no. (%) | 148 (36.4%) |
Needle passes | |
Number of needle passes, median [IQR] | |
No. 1, no. (%) | 50 (12.3%) |
No. 2, no. (%) | 96 (23.6%) |
No. 3, no. (%) | 132 (32.4%) |
No. 4, no. (%) | 68 (16.7%) |
No. 5, no. (%) | 61 (15.0%) |
EUS-TA specimen | |
Slides, no. (%) | 316 (77.6%) |
Formalin vials, no. (%) | 91 (22.4%) |
Cell-block, no. (%) | 182 (44.7%) |
Pathology–adequacy | |
Overall adequacy, no. (%) | 367 (90.2%) |
Adequacy–Score 0, no. (%) | 40 (9.8%) |
Adequacy–Score 1, no. (%) | 48 (11.8%) |
Adequacy–Score 2, no. (%) | 139 (34.2%) |
Adequacy–Score 3, no. (%) | 180 (44.2%) |
Pathology–fibrosis | |
Fibrosis–not evaluable, no. (%) | 45 (11.1%) |
Fibrosis–Score 0, no. (%) | 217 (53.3%) |
Fibrosis–Score 1, no. (%) | 127 (31.2%) |
Fibrosis–Score 2, no. (%) | 18 (4.4%) |
Accuracy, no. (%) | 339 (94.7%) * |
EUS-TA Pathological Diagnosis | Total (No. 407) |
---|---|
Adenocarcinoma, no. (%) | 268 (65.9%) |
Ductal, no. | 254 |
Mucinous, no. | 6 |
Mixed adeno-squamous, no. | 3 |
Acinar, no. | 2 |
Hepatoid, no. | 1 |
Micro-glandular, no. | 1 |
Pleomorphic, no. | 1 |
Cholangiocarcinoma, no. (%) | 1 (0.2%) |
Well-differentiated neuroendocrine neoplasm, no. (%) | 15 (3.7%) |
Neuroendocrine carcinoma, no. (%) | 3 (0.7%) |
Chronic pancreatitis, no. (%) | 10 (2.5%) |
Autoimmune pancreatitis, no. (%) | 2 (0.5%) |
Metastasis, no. (%) | 10 (2.5%) |
Renal cancer, no. | 7 |
Lung cancer, no. | 2 |
Lung neuroendocrine carcinoma, no. | 1 |
Benign lymphoid tissue, no. (%) | 10 (2.5%) |
Benign pancreatic cells with no atypia, no. (%) | 48 (11.8%) |
Non-diagnostic, no. (%) | 40 (9.8%) |
Adequacy of EUS-TA | ||||
---|---|---|---|---|
Univariate Analysis (OR [95% C.I.) | p | Multivariate Analysis (OR [95% C.I.) | p | |
Gender (male) | ns | ns | --- | --- |
Age | 1.02 [1.00–1.05] | 0.05 | ns | ns |
Study period 2015–2020 | ns | ns | --- | --- |
Size | 1.03 [1.01–1.06] | 0.04 | ns | ns |
Location (head/uncinate process) | 0.31 [0.12–0.82] | 0.02 | 0.37 [0.14–0.99] | 0.05 |
FNA needle | ns | ns | --- | --- |
FNB needle | ns | ns | --- | --- |
Second-gen. FNB needle | ns | ns | --- | --- |
19-gauge needle | ns | ns | --- | --- |
20-gauge needle | ns | ns | --- | --- |
22-gauge needle | ns | ns | --- | --- |
25-gauge needle | ns | ns | --- | --- |
22G or 25G needle | ns | ns | --- | --- |
Needle passes ≥ 3 | 3.01 [1.54–5.88] | 0.001 | 4.53 [2.22–9.28] | <0.001 |
Slides | ns | ns | --- | --- |
Cell block | 6.52 [2.50–17.0] | 0.001 | 8.82 [3.26–23.8] | <0.001 |
Score fibrosis 1 or 2 | ns | ns | --- | --- |
Adequacy of EUS-TA | ||||
---|---|---|---|---|
Univariate Analysis (OR [95% C.I.) | p | Multivariate Analysis (OR [95% C.I.) | p | |
Gender (male) | ns | ns | --- | --- |
Age | 1.02 [1.00–1.06] | 0.05 | 1.07 [1.03–1.11] | 0.002 |
Study period 2015–2020 | 2.05 [1.01–4.25] | 0.01 | ns | ns |
Size | ns | ns | --- | --- |
FNA needle | ns | ns | --- | --- |
FNB needle | ns | ns | --- | --- |
Second-gen. FNB needle | 4.26 [1.10–7.04] | 0.03 | 2.25 [1.05–3.22] | 0.03 |
19-gauge needle | ns | ns | --- | --- |
20-gauge needle | ns | ns | --- | --- |
22-gauge needle | ns | ns | --- | --- |
25-gauge needle | ns | ns | --- | --- |
22G or 25G needle | ns | ns | --- | --- |
Needle passes ≥ 3 | ns | ns | --- | --- |
Slides | ns | ns | --- | --- |
Cell block | ns | ns | --- | --- |
Score fibrosis 1 or 2 | 0.25 [0.12–0.62] | 0.04 | 0.30 [0.15–0.38] | 0.01 |
Adequacy of EUS-TA | ||||
---|---|---|---|---|
Univariate Analysis (OR [95% C.I.) | p | Multivariate Analysis (OR [95% C.I.) | p | |
Gender (male) | 0.12 [0.02–0.97] | 0.05 | 0.11 [0.01–0.93] | 0.04 |
Age | ns | ns | --- | --- |
Study period 2015–2020 | ns | ns | --- | --- |
Size | 1.10 [1.03–1.18] | 0.005 | 1.10 [1.03–1.18] | 0.006 |
FNA needle | ns | ns | --- | --- |
FNB needle | ns | ns | --- | --- |
Second-gen. FNB needle | ns | ns | --- | --- |
19-gauge needle | ns | ns | --- | --- |
20-gauge needle | ns | ns | --- | --- |
22-gauge needle | ns | ns | --- | --- |
25-gauge needle | ns | ns | --- | --- |
22G or 25G needle | ns | ns | --- | --- |
Needle passes ≥ 3 | ns | ns | --- | --- |
Slides | ns | ns | --- | --- |
Cell block | ns | ns | --- | --- |
Score fibrosis 1 or 2 | ns | ns | --- | --- |
Adequacy of EUS-TA | ||||
---|---|---|---|---|
Univariate Analysis (OR [95% C.I.) | p | Multivariate Analysis (OR [95% C.I.) | p | |
Gender (male) | ns | ns | --- | --- |
Age | 1.02 [1.00–1.04] | 0.03 | ns | ns |
Study period 2015–2020 | 2.00 [1.24–3.23] | 0.004 | 2.07 [1.12–3.82] | 0.02 |
Size | 1.03 [1.01–1.05] | 0.003 | 1.04 [1.01–1.06] | 0.009 |
Location (head/uncinate process) | 0.42 [0.23–0.77] | 0.005 | ns | ns |
FNA needle | ns | ns | --- | --- |
FNB needle | ns | ns | --- | --- |
Second-gen. FNB needle | ns | ns | --- | --- |
19-gauge needle | ns | ns | --- | --- |
20-gauge needle | ns | ns | --- | --- |
22-gauge needle | ns | ns | --- | --- |
25-gauge needle | ns | ns | --- | --- |
22G or 25G needle | ns | ns | --- | --- |
Needle passes ≥ 3 | 2.26 [1.40–3.65] | 0.001 | ns | ns |
Slides | ns | ns | --- | --- |
Cell block | 1.76 [1.08–2.88] | 0.02 | ns | ns |
Score fibrosis 1 or 2 | 0.28 [0.17–0.47] | <0.001 | ns | ns |
Score fibrosis 2 | 0.03 [0.01–0.06] | <0.001 | 0.03 [0.01–0.06] | <0.001 |
Score Fibrosis = 0 (No. 217) | Score Fibrosis = 1 (No. 127) | Score Fibrosis = 2 (No. 145) | p * | |
---|---|---|---|---|
Head/uncinate process (no. 248) | 136 (54.8%) | 99 (39.9%) | 13 (5.2%) | |
Neck, body, and tail (no. 114) | 81 (71.1%) | 28 (24.6%) | 5 (4.4%) | 0.001 |
Score adequacy = 1 (no. 45) | 26 (57.8%) | 11 (24.4%) | 8 (17.8%) | |
Score adequacy = 2 (no. 137) | 81 (59.1%) | 50 (36.5%) | 6 (4.4%) | |
Score adequacy = 3 (no. 180) | 110 (61.1%) | 66 (36.7%) | 4 (2.2%) | 0.001 |
Adequacy of EUS-TA | ||||
---|---|---|---|---|
Univariate Analysis (OR [95% C.I.) | p | Multivariate Analysis (OR [95% C.I.) | p | |
Gender (male) | ns | ns | --- | --- |
Age | ns | ns | --- | --- |
Study period 2015–2020 | ns | ns | --- | --- |
Size | ns | ns | --- | --- |
FNA needle | 2.93 [1.11–7.72] | 0.03 | ns | ns |
FNB needle | 0.34 [0.13–0.90] | 0.03 | ns | ns |
Second-gen. FNB needle | ns | ns | --- | --- |
19-gauge needle | ns | ns | --- | --- |
20-gauge needle | ns | ns | --- | --- |
22-gauge needle | ns | ns | --- | --- |
25-gauge needle | ns | ns | --- | --- |
22G or 25G needle | ns | ns | --- | --- |
Needle passes ≥ 3 | ns | ns | --- | --- |
Slides | ns | ns | --- | --- |
Cell block | ns | ns | --- | --- |
Score fibrosis 1 or 2 | ns | ns | --- | --- |
Score fibrosis 2 | 8.37 [2.33–30.0] | 0.001 | 8.37 [2.33–30.0] | 0.001 |
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Togliani, T.; Lisotti, A.; Rinaldi, R.; Fornelli, A.; Pilati, S.; Passigato, N.; Fusaroli, P. Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors. Cancers 2022, 14, 3544. https://doi.org/10.3390/cancers14143544
Togliani T, Lisotti A, Rinaldi R, Fornelli A, Pilati S, Passigato N, Fusaroli P. Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors. Cancers. 2022; 14(14):3544. https://doi.org/10.3390/cancers14143544
Chicago/Turabian StyleTogliani, Thomas, Andrea Lisotti, Rosa Rinaldi, Adele Fornelli, Stefano Pilati, Nicola Passigato, and Pietro Fusaroli. 2022. "Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors" Cancers 14, no. 14: 3544. https://doi.org/10.3390/cancers14143544
APA StyleTogliani, T., Lisotti, A., Rinaldi, R., Fornelli, A., Pilati, S., Passigato, N., & Fusaroli, P. (2022). Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors. Cancers, 14(14), 3544. https://doi.org/10.3390/cancers14143544