title: Addition of Endoscopic Ultrasound (EUS)-Guided Fine Needle Aspiration and On-Site Cytology to EUS-Guided Fine Needle Biopsy Increases Procedure Time but Not Diagnostic Accuracy.
abstract: OBJECTIVE
  Although the diagnostic accuracy of endoscopic ultrasound with fine needle aspiration (EUS-FNA) in pancreas adenocarcinoma is high, endoscopic ultrasound with fine needle biopsy (EUS-FNB) is often required in other lesions; in these cases, it may be possible to forgo initial EUS-FNA and rapid on-site cytology evaluation (ROSE). The aim of this study was to compare the diagnostic accuracy of EUS-FNB alone (EUS-FNB group) with a conventional sampling algorithm of EUS-FNA with ROSE followed by EUS-FNB (EUS-FNA/B group) in nonpancreas adenocarcinoma lesions.
  
  
  METHODS
  Retrospective cohort study of subjects who underwent EUS sampling of nonpancreatic adenocarcinoma lesions between February 2011 and May 2013.
  
  
  RESULTS
  Over the study period, there were 43 lesions biopsied in 41 unique patients in the EUS-FNB group and 53 patients in the EUS-FNA/B group. Overall diagnostic accuracy was similar between the EUS-FNB and EUS-FNA/B groups (83.7% vs. 84.9%; p=1.0). In the subgroup of subepithelial mass lesions, diagnostic accuracy remained similar in the EUS-FNB and EUS-FNA/B groups (81.0% and 70.6%; p=0.7). EUS-FNB procedures were significantly shorter than those in the EUS-FNA/B group (58.4 minutes vs. 73.5 minutes; p<0.0001).
  
  
  CONCLUSIONS
  EUS-FNB without on-site cytology provides a high diagnostic accuracy in nonpancreas adenocarcinoma lesions. There appears to be no additive benefit with initial EUS-FNA but this requires further study in a prospective study.
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Krishnan
authors.affiliation: Division of Gastroenterology, University of Colorado, Denver, CO, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
keywords: Biopsy, fine-needle; Endosonography; Subepithelial masses; Submucosal