Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?

Pancreatic carcinoma is an aggressive tumour with increasing incidence in both sexes worldwide. Early detection is, therefore, essential for patient management. A recent advancement involves the utilization of larger, thicker gauge needles, which enable the collection of core-type biopsies (FNB). Here, we investigated the role of fine needle aspiration and cytopathology in the diagnostic workflow of pancreatic lesions. A search query was designed to search for articles in the PubMed database comparing FNA and FNB for biopsy of pancreatic lesions, and detailed data were extracted from selected studies. Statistical analyses were performed using the R package meta version 6.2. Twenty-one studies made the final cut for data extraction. Overall, median age was 64.3 years (+/- 6.1; 47.6-71.5), male: female proportion 53.9 (+/- 11.3; 27.6-67.4), lesion size 3.1 cm (+/- 0.5; 1.9-4.2 cm) and percentage of malignant cases 78.3% (+/- 26.8; 2.1-100). FNA and FNB diagnostic yield was 85.8% (+/- 10.3; 70.0-100.0) and 89.2% (+/- 7.7; 70.0-98.6), respectively. Average accuracy was 89.5% (+/- 11.7; 63.0-100.0) for FNA and 90.8% (+/- 7.1; 77.0-100.0) for FNB. Adverse effects rate was 1.0% (+/- 1.3; 0-4.3) for FNA and 2.2% (+/- 4.4; 0-16.1) for FNB. None of the selected variables had a significant statistical difference between both methods. FNA and FNB perform similarly for diagnostic material acquisition in pancreatic lesions. The best outcome comes from the association of both techniques, emphasizing the value of combining cytological and histological morphology for the most accurate analysis. Much has been debated about the supposed advantages of FNB versus FNA sample acquisition for pancreatic lesions, with limited improvement in clinical parameters. According to our analysis, FNA and FNB perform similarly for diagnostic material acquisition in pancreatic lesions, with room for association of both techniques, emphasizing the value of combining cytological and histological morphology for the most accurate analysis.image