Acquiring Higher-Quality Pancreatic Neoplasm Tissue Samples Under Contrast-Enhanced Endoscopic Ultrasound-Guided Fine-Needle Biopsy

Background: Comprehensive Genomic Profiling (CGP) requires sufficient tumor cellularity for successful next-generation sequencing. Pancreatic tumors often develop necrosis, which complicates sample collection. Contrast-enhanced endoscopic ultrasonography (CE-EUS) evaluates tumor viability, potentially improving sampling efficiency. We evaluated whether CE-EUS effectively increases the yield of tumor nuclei (TN) in endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) and improves CGP success rates. Methods: This prospective study included 44 pancreatic neoplasm patients undergoing EUS-FNB for CGP between November 2021 and March 2024. Tumors were classified as non-necrotic or necrotic on CE-EUS images. Tumors in the non-necrotic group were punctured twice at the center (group A), whereas those in the necrotic group were punctured twice from contrast-enhanced (group B) and non-contrast (group C) areas. Percent TN (%TN), tissue section area, DNA integrity number (DIN), DNA concentration, white tissue core length, and histological scores were compared among the three groups. Results: Necrosis was observed in 23 patients (53%). Groups A and B had significantly higher DNA concentrations than group C (group A [n=20]: 0.97 ng/μL; group B [n=23]: 0.42 ng/μL; and group C [n=23]: 0.22 ng/μL: A vs C, P<0.01, B vs C, P=0.04). Groups A and B showed trends toward longer white cores (P=0.18) and larger tissue areas (P=0.19) than those in group C. The DIN, %TN, and histological scores were similar across groups. Conclusions: Tissue sampling using CE-EUS yielded high-quality specimens, suggesting that CE-EUS is a valuable technique for the treatment of CGP in cases of pancreatic neoplasms (Japan Registry of Clinical Trials no. 1062210071).