The following is a summary of “Endoscopic ultrasound-guided fine needle biopsy using macroscopic on-site evaluation technique reduces the number passes yet maintains a high diagnostic accuracy: A randomized study,” published in the September 2024 issue of Gastroenterology by Sonthalia et al.

Rapid on-site cytological evaluation (ROSE) during endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) can boost diagnostic success, but it is not always available. Macroscopic on-site evaluation (MOSE) is another option, though it lacks standardization for EUS-guided fine-needle biopsy (FNB).

Researchers conducted a retrospective study assessing how well MOSE performs compared to the conventional EUS-TA technique using a core biopsy needle. 

They randomly assigned consecutive patients undergoing EUS-FNA for solid lesions to either the MOSE or conventional group. The primary outcomes measured included diagnostic accuracy, yield, sensitivity, specificity, predictive values, and the number of passes while evaluating optimum parameters for macroscopically visible core (MVC). 

The results showed that 96 patients were enrolled, 48 in the conventional group and 48 in the MOSE group. The average lesion size was more significant in the MOSE group (32.67 ± 7.22 mm vs. 29.31 ± 6.98 mm, P= 0.023). Diagnostic accuracy was similar (95.8% for MOSE vs. 91.6% for conventional), as was the diagnostic yield (97.9% vs. 95.8%) and procedure duration. However, the MOSE group required fewer passes (2 vs. 3, P=0.000). For malignancy diagnosis, a total MVC length of 11.5 mm with MOSE had 93.3% sensitivity, and 2.5% MVC cores (each 4 mm) had 86.7% sensitivity. 

Investigators concluded that EUS-FNB with MOSE is a straightforward and dependable method that achieves high diagnostic accuracy with fewer passes. Longer lengths and more MVCs enhance sensitivity for diagnosing malignancy using this technique.

Source: onlinelibrary.wiley.com/doi/abs/10.1111/jgh.16744