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World J Gastroenterol. Mar 28, 2023; 29(12): 1863-1874
Published online Mar 28, 2023. doi: 10.3748/wjg.v29.i12.1863
Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor
Sakue Masuda, Kazuya Koizumi, Kento Shionoya, Ryuhei Jinushi, Makomo Makazu, Takashi Nishino, Karen Kimura, Chihiro Sumida, Jun Kubota, Chikamasa Ichita, Akiko Sasaki, Masahiro Kobayashi, Makoto Kako, Uojima Haruki
Sakue Masuda, Kazuya Koizumi, Kento Shionoya, Ryuhei Jinushi, Makomo Makazu, Takashi Nishino, Karen Kimura, Chihiro Sumida, Jun Kubota, Chikamasa Ichita, Akiko Sasaki, Masahiro Kobayashi, Makoto Kako, Department of Gastroenterology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Uojima Haruki, Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
Author contributions: Masuda S and Koizumi K were major contributors to writing the manuscript; Shionoya K, Jinushi R, Makazu M, Nishino T, and Kimura K designed the outline and coordinated the writing of the manuscript; Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, and Haruki U provided input for writing the paper.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sakue Masuda, MD, Chief Doctor, Department of Gastroenterology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan. sakue.masuda@tokushukai.jp
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 22, 2023
Revised: February 2, 2023
Accepted: March 15, 2023
Article in press: March 15, 2023
Published online: March 28, 2023
Processing time: 91 Days and 9.8 Hours
Abstract

Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030, a high mortality rate considering the number of cases. Surgery and chemotherapy are the main treatment options, but they are burdensome for patients. A clear histological diagnosis is needed to determine a treatment plan, and endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract seeding. With the development of personalized medicine and precision treatment, there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure, leading to the development of the fine-needle biopsy (FNB) needle. EUS-FNB is rapidly replacing EUS-guided fine-needle aspiration (FNA) as the procedure of choice for EUS-TA of pancreatic cancer. However, EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions, so it is important clinicians are familiar with both. Given these recent dev-elopments, we present an up-to-date review of the role of EUS-TA in pancreatic cancer. Particularly, technical aspects, such as needle caliber, negative pressure, and puncture methods, for obtaining an adequate specimen in EUS-TA are discussed.

Keywords: Endoscopic ultrasound-guided fine needle biopsy; Endoscopic ultrasound-guided tissue acquisition; Personalized medicine; Genomic profiling test; Pancreatic cancer; Puncture procedure

Core Tip: Endoscopic ultrasound (EUS)-guided tissue acquisition (TA) began in 1992 as EUS-guided fine-needle aspiration (FNA). Recently, with the development of personalized medicine and precision treatment, the fine-needle biopsy (FNB) needle was developed. EUS-FNB is rapidly replacing EUS-FNA for pancreatic cancer. The EUS-TA strategy with three or more punctures, the stylet retraction method, the torque or fanning technique, and a 22-G or thicker FNB needle may be effective in patients with solid pancreatic tumors scheduled for treatment, including personalized medicine. It is also important clinicians are familiar with both procedures, as EUS-FNA is occasionally necessary when FNB is unsuccessful.