Better Diagnostic Accuracy of Endoscopic Ultrasound-Guided FNAC than Needle Core Biopsy, Suggests Study

While EUS-guided tissue acquisition (EUS TA) techniques, specifically EUS FNAC and EUS FNB, are established diagnostic mainstays, their distinct operational pros and cons create a clinical gap in optimizing tissue yield efficiently; to address this, researchers Mohd Rafiq Najar, Monika Jain, Gurwant Singh Lamba, and Sawan Bopanna aimed to compare the diagnostic accuracy of EUS FNAC without on-site pathology versus EUS FNB performed sequentially during the identical endoscopic session.

Therefore, in the prospective observational study encompassing 58 patients presenting with solid intra-abdominal masses, investigators performed back-to-back EUS FNAC and EUS FNB in the same procedural setting, visually evaluating EUS FNB specimens for adequacy and preparing both air-dried and alcohol-fixed cytology smears to comprehensively evaluate diagnostic accuracy against the final clinical diagnoses.

Key Clinical Findings of the Study Includes:

• Diagnostic Accuracy: Investigators noted an exceptional diagnostic accuracy of 98.2% for EUS FNB utilizing macroscopic on-site evaluation (MOSE) compared to a highly competitive 93.1% for EUS FNAC without ROSE, establishing that no statistically significant difference exists between the two techniques.

• Sensitivity and Specificity: Researchers reported that EUS FNAC demonstrated a robust sensitivity of 92.4% and a flawless specificity of 100%, closely trailing the impressive 98.1% sensitivity and 100% specificity seen with the EUS FNB method.

• Patient Demographics and Lesion Sites: Scientists highlighted that the 58-patient cohort, consisting of an equal gender split with a mean age of 53.91 years, predominantly presented with varied lesions, primarily lymph nodal masses (53.4%) and pancreatic masses (32.7%).

• Malignancy Detection: Clinicians found that the EUS FNB procedure successfully diagnosed malignancy in 65.5% of cases and benign diseases in 32.7% of the cohort, leaving only a single patient case (1.7%) as diagnostically inconclusive.

• Procedural Efficiency: Authors observed that while the required number of needle passes was higher in the EUS FNAC cohort compared to the EUS FNB group, this variance did not reach statistical significance, indicating a comparable overall procedural effort.

The results suggest that both diagnostic modalities are remarkably comparable in safely assessing solid intra-abdominal masses, with EUS FNAC yielding a 93.1% diagnostic accuracy and EUS FNB yielding a 98.2% accuracy without significant compromises in sample adequacy, safety profiles, or the required number of needle passes.

Thus, the study concludes that clinical practice, particularly in resource-constrained medical environments, utilizing either of these diagnostic approaches independently may be entirely adequate for securing a reliable diagnosis, though obtaining core biopsies via EUS FNB could be selectively prioritized when the preservation of intact tissue architecture is clinically necessary.

While specific limitations are not explicitly outlined in the provided study text, the promising findings suggest that extending this research into broader future trials could further validate the independent utility of these comparable diagnostic modalities across diverse clinical settings.

Reference

Najar, M. R., Jain, M., Lamba, G. S., & Bopanna, S. (2025). EUS FNAC without rapid on-site evaluation is comparable to EUS FNB with macroscopic on-site evaluation in evaluation of intra-abdominal masses. Indian Journal of Gastroenterology, 44, 371–377.