Hedenström P, et al. – Researchers studied the diagnostic accuracy and clinical impact of endoscopic ultrasound (EUS)–guided biopsy sampling (EUS–FNB) with a reverse bevel needle compared with that of fine needle aspiration (EUS–FNA) in the work–up of subepithelial lesions (SEL) in a tertiary center setting. EUS–FNB with a reverse bevel needle demonstrated as safe and superior to EUS–FNA in providing a conclusive diagnosis of subepithelial lesions. This biopsy sampling approach seemed to facilitate a rational clinical management and accurate treatment.

Methods

• Researchers prospectively included all patients presenting with SELs referred for EUS-guided sampling from 2012 to 2015.
• After randomization of the first pass modality, they performed dual sampling with both EUS-FNB and EUS-FNA in each lesion.
• An intention-to-diagnose analysis assessed the diagnostic accuracy, technical failures, and adverse events.
• They measured the clinical impact as the performance of additional diagnostic procedures post-EUS and the rate of unwarranted resections compared with a reference cohort of SELs sampled in the same institution 2006–2011.

Results

• In 70 dual sampling procedures of unique lesions (size: 6–220 mm), EUS-FNB was superior to EUS-FNA regarding the diagnostic sensitivity for malignancy and the overall accuracy (90 vs 52%, and 83 vs 49%, both p < 0.001).
• Low adverse event rate (1.2%) was observed with EUS-FNB.
• In 2012–2015, EUS-FNB indicated a positive clinical impact in comparison with the reference cohort demonstrated by less cases referred for an additional diagnostic procedure, 12/83 (14%) vs 39/73 (53%), p < 0.001, and fewer unwarranted resections in cases subjected to surgery, 3/48 (6%) vs 12/35 (34%), p = 0.001.