Role of macroscopic on-site evaluation of endoscopic ultrasound-guided fine-needle aspiration/biopsy: Results of a multicentric prospective study

doi:10.4253/wjge.v16.i11.595

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World Journal of Gastrointestinal Endoscopy

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Observational Study

World J Gastrointest Endosc. Nov 16, 2024; 16(11): 595-606
Published online Nov 16, 2024. doi: 10.4253/wjge.v16.i11.595

Table 1 Macroscopic on-site evaluation - 2 classification[5]

Score	Aspects of the core	Classification of the biopsy
0	No material	Negative
1	Haematic or necrotic material	Acceptable
2	≥ 1 core tissue with ≤ 2 mm yellowish-white	Positive
3	≥ 1 core tissue with > 2 mm yellowish-white	Positive

Table 2 Baseline characteristics of patients who underwent macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle aspiration or biopsy

Characteristics
Age (years), mean ± SD	59 ± 12
Sex, n (%)
Female	499 (49.5)
Male	509 (50.5)
Lesion location, n (%)
Pancreas	664 (62)
Stomach	101 (9.4)
Lymph nodes	96 (8.9)
Liver	46 (4.2)
Mediastinum	38 (3.5)
Other	129 (12)
Total	1074 (100)
The mean size of the target lesion on EUS (mm), mean ± SD	38 ± 17
Approach, n (%)
Transduodenal	585 (58)
Transgastric	350 (34.7)
Transesophageal	62 (6.2)
Transrectal	11 (1.1)
Type of the needle (FNA or FNB), n (%)
FNA	101 (10)
FNA-Expect-Boston	68 (6.7)
FNA-EchoTip-Cook	33 (3.3)
FNB	907 (90)
FNB-Acquire-Boston	751 (74.5)
FNB-Medtronic	20 (2)
FNB-ProCore-Cook	40 (4)
FNB-Trident-Microtech	96 (9.5)
Specimen acquisition method, n (%)
Suction method	381 (37.8)
Capillary method	290 (28.8)
Both	337 (33.4)
Number of needle passes (FNB), n (%)
1	154 (15.3)
2	680 (67.5)
3	149 (14.8)
4	25 (2.5)
Final diagnosis (conclusive or inconclusive), n (%)
Conclusive	963 (95.5)
Benign	102 (10.1)
Malignant	861 (85.4)
Inconclusive	45 (4.5)
Postprocedural adverse events, n (%)
No	975 (96.7)
Yes	33 (3.3)
Abdominal pain	17 (1.7)
Small blood collection	10 (1)
Transient fever	6 (0.6)

EUS: Endoscopic ultrasound; FNA: Fine-needle aspiration; FNB: Fine-needle biopsy.

Table 3 Macroscopic on-site evaluation-1 and macroscopic on-site evaluation-2 classifications

Classification
MOSE-1 classification, n (%)
Score 1: Definite visible tissue core with scanty blood clots	618 (61.3)
Score 2: Visible tissue core with moderate blood clots	325 (32.2)
Score 3: Scanty tissue core with mainly blood clots	65 (6.5)
MOSE-2 classification, n (%)
Score 0: Punctio sicca/no material	0 (0)
Score 1: Only necrotic or haematic material	44 (4.4)
Score 2: ≥ 1 core tissue, ≤ 2 mm yellowish-white	194 (19.2)
Score 3: ≥ 1 core tissue, > 2 mm yellowish-white	770 (76.4)

MOSE: Macroscopic on-site evaluation.

Table 4 Relation between macroscopic on-site evaluation classifications and the type of needles and tissue acquisition techniques

	MOSE-1 classification				MOSE-2 classification
	1, n (%)¹	2, n (%)¹	3, n (%)¹	P value	Scores 0 and 1, n (%)¹	Scores 2 and 3, n (%)¹	P value
Type of the needle
FNA-EchoTip	13 (39.4)	15 (45.5)	5 (15.2)	< 0.001	1 (3)	32 (97)	0.009
FNA-Expect	37 (54.4)	28 (41.2)	3 (4.4)		7 (10.3)	61 (89.7)
FNB-Acquire	465 (61.9)	241 (32.1)	45 (6)		33 (4.4)	718 (95.6)
FNB-Medtronic	4 (20)	10 (50)	6 (30)		3 (15)	17 (85)
FNB-Pro Core	12 (30)	22 (55)	6 (15)		0 (0)	40 (100)
FNB-Trident-Microtech	87 (90.6)	9 (9.4)	0 (0)		0 (0)	96 (100)
Type of the needle (FNA or FNB)
FNA	50 (49.5)	43 (42.6)	8 (7.9)	0.036	8 (7.9)	93 (92.1)	0.073
FNB	568 (62.6)	282 (31.1)	57 (6.3)	0.036	36 (4)	871 (96)	0.073
Size of the needle
19 G	13 (44.8)	11 (37.9)	5 (17.2)	0.034	4 (13.8)	25 (86.2)	0.249
20 G	11 (28.9)	20 (52.6)	7 (18.4)		1 (2.6)	37 (97.4)
22 G	594 (63.1)	294 (31.2)	53 (5.6)		39 (4.1)	902 (95.9)
Specimen acquisition method
Both	248 (73.6)	69 (20.5)	20 (5.9)	< 0.001	9 (2.7)	328 (97.3)	0.026²
Capillary method	150 (51.7)	116 (40)	24 (8.3)		10 (3.4)	280 (96.6)
Suction method	220 (57.7)	140 (36.7)	21 (5.5)		25 (6.6)	356 (93.4)
Number of needle passes
1	89 (57.8)	60 (39)	5 (3.2)	< 0.001	4 (2.6)	150 (97.4)	< 0.001
2	451 (66.3)	197 (29)	32 (4.7)		15 (2.2)	665 (97.8)
3	67 (44.9)	56 (37.6)	26 (17.5)		16 (10.7)	133 (89.3)
4	11 (44)	12 (48)	2 (8)		9 (36)	16 (64)

¹Percentages were calculated within the row.

²Both vs suction (P value = 0.021).

P value < 0.05 is considered significant. MOSE: Macroscopic on-site evaluation; FNA: fine-needle aspiration; FNB: Fine-needle biopsy.

Table 5 Relation between the final diagnosis and the type and size of the needle

	Final diagnosis
	Inconclusive, n (%)¹	Conclusive, n (%)¹	P value
Type of needle
FNA-EchoTip-Cook	4 (12.1)	29 (87.9)	0.035^a
FNA-Expect-Boston	1 (1.5)	67 (98.5)
FNB-Franseen Acquire-Boston	39 (5.2)	712 (94.8)
FNB-Medtronic	0 (0)	20 (100)
FNB-ProCore-Cook	1 (2.5)	39 (97.5)
FNB-Trident-Microtech	0 (0)	96 (100)
Type of needle (FNA or FNB)
FNA	5 (5)	96 (95)	0.803
FNB	40 (4.4)	867 (95.6)	0.803
Size of the needle
19 G	3 (10.3)	26 (89.7)	0.176
20 G	3 (7.9)	35 (92.1)
22 G	39 (4.1)	902 (95.9)
Specimen acquisition method
Both	10 (3)	327 (97)	0.079
Capillary method	11 (3.8)	279 (96.2)
Suction method	24 (6.3)	357 (93.7)
MOSE-1 classification
Good cores (score 1)	16 (2.6)	602 (97.4)	< 0.001^a
Bloody cores (scores 2 and 3)	29 (7.4)	361 (92.6)	< 0.001^a
MOSE-2 classification
Score 2	14 (7.2)	180 (92.8)	0.002^a
Score 3	20 (2.6)	750 (97.4)	0.002^a

^aP value < 0.05 is considered significant.

¹Percentages were calculated within the row.

MOSE: Macroscopic on-site evaluation; FNA: fine-needle aspiration; FNB: Fine-needle biopsy.

Table 6 Comparison between scores 2 and 3 in the macroscopic on-site evaluation-2 classification

	MOSE-2 classification		P value
	Score 2, n (%)¹	Score 3, n (%)¹	P value
Diagnosis conclusive or inconclusive
Inconclusive	14 (7.2)	20 (2.6)	0.002^a
Conclusive	180 (92.8)	750 (97.4)	0.002^a
Final diagnosis
Inconclusive	14 (7.2)	20 (2.6)	< 0.001^a
Benign	35 (18)	60 (7.8)
Malignant	145 (74.7)	690 (89.6)
Number of needle passes FNB1
1	32 (16.5)	118 (15.3)	< 0.001^a
2	103 (53.1)	562 (73)
3	56 (28.9)	77 (10)
4	3 (1.5)	13 (1.7)

^aP value < 0.05 is considered significant.

¹Percentages were calculated within the column.

MOSE: Macroscopic on-site evaluation; FNBI: First Nations Biomonitoring Initiative.

Citation: Okasha HH, Hussein HA, Ragab KM, Abdallah O, Rouibaa F, Mohamed B, Ghalim F, Farouk M, Lasheen M, Elbasiony MA, Alzamzamy AE, El Deeb A, Atalla H, El-Ansary M, Mohamed S, Elshair M, Khannoussi W, Abu-Amer MZ, Elmekkaoui A, Naguib MS, Ait Errami A, El-Meligui A, El-Habashi AH, Ameen MG, Abdelfatah D, Kaddah M, Delsa H. Role of macroscopic on-site evaluation of endoscopic ultrasound-guided fine-needle aspiration/biopsy: Results of a multicentric prospective study. World J Gastrointest Endosc 2024; 16(11): 595-606
URL: https://www.wjgnet.com/1948-5190/full/v16/i11/595.htm
DOI: https://dx.doi.org/10.4253/wjge.v16.i11.595