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World J Gastroenterol. Sep 14, 2026; 32(34): 118873
Published online Sep 14, 2026. doi: 10.3748/wjg.118873
Diagnostic performance of fine-needle aspiration vs fine-needle biopsy in solid pancreatic lesions based on pathologist expertise: A prospective multicenter trial
Antonio Afonso Miranda Neto, Vitor Ottoboni Brunaldi, Alberto Machado da Ponte Neto, Rafael Kemp, José Sebastião dos Santos, Joel Del Bel Pádua, Mariangela Ottoboni Brunaldi, Francisco Antonio Araújo Oliveira, José Ruver Lima Herculano Júnior, Danielle Azevedo Chacon, Guilherme Henrique Peixoto de Oliveira, Igor Braga Ribeiro, Sergio Eiji Matuguma, Eduardo Guimarães Hourneaux de Moura
Antonio Afonso Miranda Neto, Guilherme Henrique Peixoto de Oliveira, Igor Braga Ribeiro, Sergio Eiji Matuguma, Eduardo Guimarães Hourneaux de Moura, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-010, Brazil
Vitor Ottoboni Brunaldi, Rafael Kemp, José Sebastião dos Santos, Department of Surgery and Anatomy, Medical School of Ribeirão Preto of the University of São Paulo, São Paulo 14049-900, Brazil
Alberto Machado da Ponte Neto, Francisco Antonio Araújo Oliveira, José Ruver Lima Herculano Júnior, Endoscopy Service, Hospital Geral de Fortaleza, Fortaleza 60150-160, Brazil
Joel Del Bel Pádua, Mariangela Ottoboni Brunaldi, Department of Pathology and Forensic Medicine, Medical School of Ribeirão Preto of the University of São Paulo, São Paulo 14049-900, Brazil
Danielle Azevedo Chacon, Department of Pathology, University of São Paulo School of Medicine, São Paulo 05403-010, Brazil
Author contributions: Miranda Neto AA and Kemp R contributed to the conception and design of the study; Miranda Neto AA, Kemp R, da Ponte Neto AM, Oliveira FAA, Herculano Júnior JRL, Chacon DA, de Oliveira GHP, Ribeiro IB, Matuguma SE, and de Moura EGH drafted the article; Miranda Neto AA, Kemp R, da Ponte Neto AM, Oliveira FAA, Herculano Júnior JRL, Chacon DA, de Oliveira GHP, Ribeiro IB, Matuguma SE, de Moura EGH, dos Santos JS, Pádua JDB, Brunaldi MO, and Brunaldi VO analyzed and interpreted the data, and revised the article for important intellectual content; and all authors approved the final version.
Institutional review board statement: The study was approved by the Research Ethics Committee of Hospital das Clínicas of the Medical School of the University of São Paulo, No. 37048419.6.1001.0068, Ethics Committee of Hospital das Clínicas of the Medical School of Ribeirão Preto, No. 37048419.6.2002.5440; and Ethics Committee of Hospital Geral de Fortaleza, No. 37048419.6.2001.5040.
Clinical trial registration statement: The trial was registered at ensaiosclinicos.gov.br, No. U1111-1257-6714.
Informed consent statement: All subjects agreed to participate in this study after informed consent and ethical permission was obtained.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Corresponding author: Igor Braga Ribeiro, MD, PhD, Associate Research Scientist, Department of Gastroenterology, University of São Paulo School of Medicine, Av. Dr Enéas de Carvalho Aguiar, 225, 6º andar, Bloco 3, Cerqueira Cesar, São Paulo 05403-010, Brazil.
igorbraga1@gmail.com
Received: January 13, 2026
Revised: February 13, 2026
Accepted: April 13, 2026
Published online: September 14, 2026
Processing time: 218 Days and 9.7 Hours
BACKGROUND
Pancreatic cancer has one of the highest mortality rates among malignant tumors, with increasing prevalence and ranking sixth as the leading cause of cancer death worldwide. Histological diagnosis is made preferably by using tissue samples obtained with endoscopic ultrasound, using fine-needle aspiration (FNA) or fine-needle biopsy (FNB) needles. Currently, there are no studies comparing the sensitivity between punctures performed with both needles, when evaluated and compared by general pathologists and experts in pancreaticobiliary cytology.
AIM
To compare the diagnostic yield for suspected solid pancreatic malignancies using 22-gauge FNA and FNB needles between general pathologists and experts in pancreaticobiliary cytology focus on positive detection rate.
METHODS
Thirty patients were selected and underwent endoscopic ultrasound-guided punctures using FNA and FNB needles, for a total of 4 punctures per patient. All samples were analyzed by a general pathologist and an expert pathologist. Sensitivity was the diagnostic parameter evaluated.
RESULTS
Overall, 100 slides [83.3%, 95% confidence interval (CI): 75.9%-89.2%] were considered positive by general pathologists, while 95 slides (79.2%, 95%CI: 71.3%-85.7%) were considered positive by expert pathologists. General pathologists from the Hospital das Clínicas of the Medical School of the University of São Paulo and Hospital das Clínicas of the Medical School of Ribeirão Preto centers (high-volume centers) concluded that 90% of the samples (95%CI: 78%-96.5%) were positive, whereas those from the Hospital Geral de Fortaleza center (low-volume center) considered 70% of the samples positive (95%CI: 54.8%-82.4%). When comparing sensitivity between different needles and centers, and controlling for the expertise of the pathologist, FNB showed significantly superior performance for general pathologists (FNB: 85%, 95%CI: 62.1%-96.8% vs FNA: 55%, 95%CI: 31.5%-76.9%; P = 0.042).
CONCLUSION
In low-volume centers, the use of FNB may help improve the diagnostic sensitivity of general pathologists.
Core Tip: The diagnostic yield of endoscopic ultrasound-guided tissue acquisition for solid pancreatic lesions is influenced by needle design, pathologist expertise, and institutional volume. This study shows that fine-needle biopsy provides superior diagnostic sensitivity compared with fine-needle aspiration when specimens are assessed by general pathologists, particularly in low-volume centers. These findings support fine-needle biopsy as a practical strategy to improve diagnostic reliability and reduce dependence on specialized cytopathology in routine clinical practice.
