Clin Endosc.  2023 Mar;56(2):221-228. 10.5946/ce.2022.086.

Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer

• Okuno N
• Hara K
• Mizuno N
• Haba S
• Kuwahara T
• Kuraishi Y
• Fumihara D
• Yanaidani T

• KMID: 2540740
• DOI: http://doi.org/10.5946/ce.2022.086

Abstract

Background/Aims
Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting.
Methods
CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively.
Results
The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375).
Conclusions
To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

Keyword

Endoscopic Ultrasound-Guided Fine Needle Aspiration; Genome; Pancreatic neoplasms

Figure

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  Fig. 1. Adequate and inadequate histologic specimens obtained by EUS-FNB in the same patient (hematoxylin and eosin stain). (A) Initial inadequate sample obtained with one puncture, using a 22 G-FNB needle with suction, and processed in cell block. Although this sample was sufficient for diagnosis, it did not meet the prescreening criteria for comprehensive genomic profiling due to insufficient material. (B) Adequate sample obtained at re-EUS-TA with four punctures, using a 19 G-FNB needle without suction, placed in formalin directly and processed in biopsy. The sample could be analyzed by FoundationOne CDx (Foundation Medicine Inc.). EUS, endoscopic ultrasound; FNB, fine-needle biopsy; TA, tissue acquisition.

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  Fig. 2. Mutation frequency of major driver genes for pancreatic ductal adenocarcinoma.

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