The Use of Endoscopic Ultrasound Guided Fine Needle Biopsy for the Diagnosis of Microcystic Serous Cystic Neoplasms of the Pancreas

Background: Pancreatic cysts, frequently identified incidentally on imaging, present diagnostic challenges due to their variable malignant potential. Serous cystic neoplasms (SCNs) are benign and account for 1-2% of pancreatic lesions. However, imaging techniques alone often lack the accuracy to definitively diagnose these lesions, leading to unnecessary surveillance and interventions. Aims: This study evaluates the safety and diagnostic efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for identifying microcystic SCNs. Methods: We conducted a retrospective analysis of 39 patients who underwent EUS-FNB for solitary pancreatic lesions with microcystic features, identified through cross-sectional imaging at our medical center between 2018 and 2024. Patients with a stellate scar or definitive imaging features of microcystic SCNs were excluded. Outcomes assessed included histologic results and complications. Results: Histological confirmation of microcystic SCN was achieved in 79.5% of cases, eliminating the need for further imaging and surveillance. A single complication—mild intra-lesional bleeding—occurred in one patient, which resolved without further intervention. Conclusions: EUS-FNB is a safe and effective method for diagnosing microcystic SCNs, offering a definitive diagnosis and reducing unnecessary surveillance and interventions. This approach provides a favorable risk-benefit profile for managing SCNs. However, future multicenter studies with larger cohorts are needed to further validate these findings and refine diagnostic protocols for pancreatic cystic neoplasms.