El-Domiaty N, Bou-Farah R, Laurent V, Bellanger C, Boytchev I, Martin A. Safety and diagnostic performance of endoscopic ultrasound-guided fine needle biopsy in pancreatic cystic and mixed lesions. World J Gastrointest Endosc 2026; 18(8): 124171 [DOI: 10.4253/wjge.124171]
Corresponding Author of This Article
Antoine Martin, Assistant professor, Department of Gastroenterology and Gastrointestinal Endoscopy, Kremlin-Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre, Paris 94800, France. antoine.martin2@aphp.fr
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Gastroenterology & Hepatology
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El-Domiaty N, Bou-Farah R, Laurent V, Bellanger C, Boytchev I, Martin A. Safety and diagnostic performance of endoscopic ultrasound-guided fine needle biopsy in pancreatic cystic and mixed lesions. World J Gastrointest Endosc 2026; 18(8): 124171 [DOI: 10.4253/wjge.124171]
World J Gastrointest Endosc. Aug 16, 2026; 18(8): 124171 Published online Aug 16, 2026. doi: 10.4253/wjge.124171
Safety and diagnostic performance of endoscopic ultrasound-guided fine needle biopsy in pancreatic cystic and mixed lesions
Nada El-Domiaty, Rita Bou-Farah, Valerie Laurent, Christophe Bellanger, Isabelle Boytchev, Antoine Martin
Nada El-Domiaty, Department of Endemic Medicine, Faculty of Medicine, Capital (Helwan) University, Cairo 12547, Egypt
Nada El-Domiaty, Rita Bou-Farah, Valerie Laurent, Christophe Bellanger, Isabelle Boytchev, Antoine Martin, Department of Gastroenterology and Gastrointestinal Endoscopy, Kremlin-Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Paris 94800, France
Author contributions: El-Domiaty N and Martin A participated in research design, acquisition of the data, analysis and interpretation of the data; drafting of the manuscript, critical revision of the manuscript, and statistical analysis; Bou-Farah R, Laurent V, Bellanger C and Boytchev I participated in critical revision and approval of the manuscript.
AI contribution statement: No AI tool was used.
Institutional review board statement: Data was obtained from electronic patient records following approval by the local hospital ethics committee (No. 20240710162845). The study was conducted in accordance with the Declaration of Helsinki and adhered to the principles of good clinical practice.
Informed consent statement: All the data was retrospectively collected from the electrical database records after the local hospital ethics committee approval by the local Kremlin-Bicêtre Hospital Ethics Committee (No. 20240710162845).
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: No additional data is available.
Corresponding author: Antoine Martin, Assistant professor, Department of Gastroenterology and Gastrointestinal Endoscopy, Kremlin-Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, 78 Rue du Général Leclerc, Le Kremlin-Bicêtre, Paris 94800, France. antoine.martin2@aphp.fr
Received: June 9, 2026 Revised: July 15, 2026 Accepted: July 27, 2026 Published online: August 16, 2026 Processing time: 62 Days and 6.2 Hours
Abstract
BACKGROUND
Mixed pancreatic cystic lesions (PCLs) could be a sign of malignant transformation from PCLs. The proper diagnosis of these lesions are crucial for management and avoiding unnecessary treatment. Endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) may improve diagnostic yield by providing histologic core tissue as well as liquid fraction samples; however, data on its safety and diagnostic performance in cystic and mixed lesions remain limited.
AIM
To evaluate the safety and diagnostic performance of EUS-FNB using a 22G needle in mixed PCLs.
METHODS
This retrospective observational cohort study was conducted at a tertiary referral center between January 2019 and December 2024. Consecutive patients undergoing EUS-FNB (22G) for pancreatic cystic or mixed lesions were included. Solid lesions and pancreatic pseudocysts were excluded. Primary outcome was procedure-related safety. Secondary outcomes included technical success, adequacy, diagnostic yield, pathological spectrum, and concordance with surgical histopathology when available. Follow-up data were collected to assess subsequent management and outcomes.
RESULTS
Among 640 EUS-guided biopsies performed during the study period, 60 patients (mean age 65.0 ± 12.1 years; 36.6% female) underwent EUS-FNB for pancreatic cystic (31.7%) or mixed lesions (68.3%). Technical success was achieved in all cases. Adequate tissue, cytology, or fluid for analysis was obtained in 57 patients (95.0%). No EUS-FNB-related adverse events were observed after review of the medical records. The most frequent diagnosis was pancreatic adenocarcinoma (40.0%), followed by serous cystadenoma (10.0%) and intraductal papillary mucinous neoplasm (10.0%). Overall diagnostic yield was 85.0%. Ten patients underwent surgical resection, with complete concordance between EUS-FNB and surgical histopathology in this selected subgroup. Over a mean follow-up of 17.0 ± 14.3 months, management included chemotherapy, surgery, surveillance, repeat EUS, or drainage according to diagnosis and multidisciplinary assessment.
CONCLUSION
EUS-FNB using a 22G needle could be a feasible approach for tissue acquisition in pancreatic cystic and mixed lesions, with high technical success and specimen adequacy in this retrospective cohort. Higher quality studies are needed to further define its clinical role and safety profile.
Core Tip: Pancreatic cystic and mixed lesions remain diagnostically challenging because conventional imaging and cyst fluid analysis may not reliably differentiate benign from premalignant or malignant lesions. In this retrospective cohort of 60 patients, Endoscopic ultrasound-fine needle biopsy using a 22G needle was feasible, with 100% technical success, 95% specimen adequacy, 85% diagnostic yield, and no procedure-related adverse events identified after medical-record review. Complete concordance with surgical histopathology was observed in the 10 resected patients, but this selected subgroup is not sufficient to estimate overall diagnostic accuracy. These results suggest that endoscopic ultrasound-fine needle biopsy can provide valuable histologic tissue for lesion characterization, particularly in mixed lesions, while prospective comparative studies remain necessary.
