Introduction

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been widely used as a safe and effective method for obtaining samples from Solid masses around the gastrointestinal tract. It is difficult for endosonographers to determine the timing of termination of EUS-FNA. However, several reports have validated macroscopic on-site evaluation (MOSE) as safe and effective.

Aims & Methods

We performed a prospective pilot study to explore the value of MOSE in evaluating the specimen quality during magnifier-based EUS-FNA and confirm the cut-off length of visible tissue core (VTC). 79 consecutive patients who underwent EUS-FNA of solid masses around the gastrointestinal tract using 22-G needles were included in the study. After EUS-FNA, endosonographers used a special observation table to on-site evaluate all puncture specimens. Then, the specimens containing VTC were prepared into cell block and stained with haematoxylin-eosin (HE). Pathologists explored the relationship between VTC length and specimen quality. Finally, the receiver-operating characteristic (ROC) curve of the VTC length, with respect to the final diagnoses were plotted, and the accuracy of the area under the curve (AUC) for diagnostic yield was evaluated and to determine the optimal cut-off VTC length with the Youden index. The utility of optimal cut-off VTC length in diagnosis was investigated.

Results

1. In this study, EUS-FNA was performed on 93 masses in 79 patients, with a total number of needle passes of 249, including 221 needle passes (88.8%) containing VTC. The completion rate of EUS-FNA was 100% and the complication rate was 1.1%. Assisted by MOSE, the sensitivity, specificity, positive predictive value, negative predictive value and histological diagnostic rate of EUS-FNA in this study were 85.9% (73/85), 100.0% (8/8), 100.0% (73/73), 40.0% (8/20) and 87.1% (81/93), respectively. The kappa statistic indicated quite high agreement between EUS-FNA histologic diagnoses and final diagnoses (Kappa=0.511, P<0.05).
2. The pathologist scored the specimen and correlation analysis was performed by Spearman’s rank-order correlation. It is concluded that a positive correlation between specimen quality (integrity of tissue structure) and VTC length (rs=0.427, P<0.05). The ROC curve of the VTC length showed the cut-off VTC length of 7.45 mm with area under the curve of 0.838. With this cut-off level, the sensitivity and specificity of EUS-FNA were 80.8% and 66.7%, respectively.
3. Multivariate analyses of factors affecting the tissue diagnostic rate of EUS-FNA were performed. Inclusion factors were the maximum diameter of lesion, location of lesion, puncture method and the VTC length. The statistical results indicated that the VTC length ≥7.45mm and the maximum diameter of lesion were associated with the higher diagnostic rate of histopathology. However, the tissue diagnostic rate was not related to the location of lesion and puncture method.

Conclusion

1. MOSE could help endosonographers better assess specimen quality, so as to predict the specimen adequacy independently. We determined that the histological diagnostic yields were significantly improved when the VTC lengths obtained by EUS-FNA ≥7.45mm.
2. MOSE based on magnifying glass is practical for improving the specimen quality and reducing the number of needle passes when ROSE is unavailable. It is a safe, effective and economical diagnostic method for the solid masses around the gastrointestinal tract.

References

1. Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 2011;106:1705-10.
2. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses. World J Gastroenterol 2014;20:9451-7.
3. Leung Ki EL, Lemaistre AI, Fumex F, et al. Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation. Endosc Int Open 2019;7:E189-E194.
4. Iwashita T, Yasuda I, Mukai T, et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study). Gastrointest Endosc 2015;81:177-85.
5. Ishiwatari H, Sato J, Fujie S, et al. Gross visual inspection by endosonographers during endoscopic ultrasound-guided fine needle aspiration. Pancreatology 2019;19:191-195.

Disclosure

The authors have nothing to disclose.

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is the most common neoplastic disease of the pancreas with a high mortality rate due to late diagnosis at an advanced stage for its asymptomatic progression. Chronic pancreatitis, one of the risk factors for the development of PDAC, complicates the diagnostic process as both conditions sometimes share overlapping clinical and pathological features. Identifying individuals at higher risk of developing the disease and detecting pancreatic cancer at an early, curable stage is critical to improving overall patient outcomes. This study investigates the potential of relative telomere length (RTL) in peripheral blood and microbiome composition as biomarkers for PDAC. These biomarkers could support a minimally invasive liquid biopsy approach for early diagnosis of PDAC, differentiation from chronic pancreatitis, and screening of high-risk individuals.

Aims & Methods

A total of 239 participants were enrolled in the study and were divided into four groups: patients with PDAC (n = 36), chronic pancreatitis (n = 60), type II diabetes mellitus (n = 91) and cancer-free individuals (n = 52). Peripheral blood samples were collected to estimate relative telomere length using the multiplex monochrome qPCR method. Stool samples from a subset comprising chronic pancreatitis patients (n = 13), PDAC patients (n = 12), and healthy controls (n = 7) were analysed using 16S rRNA sequencing for metataxonomic analysis of the gut microbiome.

Results

Microbiome analysis revealed dysbiosis in a subset of patients, with an overrepresentation of bacterial species such as Prevotella copri and Akkermansia muciniphila in chronic pancreatitis and PDAC patients. A trend towards reduced microbial diversity was observed in PDAC patients, with changes in bacterial composition already detectable in chronic pancreatitis patients. No significant differences were found in RTL between the PDAC and cancer-free patient groups, and the only risk factors associated with changes were age, gender and smoking.

Conclusion

The pilot findings suggest a general trend towards reduced microbial diversity in PDAC patients, with alterations in bacterial proportions already observed in individuals diagnosed with chronic pancreatitis. These data ptovide a basis for the development of non-invasive diagnostic strategies to improve early detection and clinical outcomes for patients with PDAC. However, relative telomere length has not been shown to be a reliable biomarker.

References

Wu H, Zou WB, Zhou DZ, Gu YT, Liao Z, Li ZS. Longer Leukocyte Telomere Length is Associated With an Increased Risk of Chronic Pancreatitis. Pancreas. 2017;46(8):e65-e66. doi:10.1097/MPA.0000000000000887
Riquelme E, Zhang Y, Zhang L, et al. Tumor Microbiome Diversity and Composition Influence Pancreatic Cancer Outcomes. Cell. 2019;178(4):795-806.e12. doi:10.1016/j.cell.2019.07.008
Antwi SO, Petersen GM. Leukocyte Telomere Length and Pancreatic Cancer Risk: Updated Epidemiologic Review. Pancreas. 2018;47(3):265-271. doi:10.1097/MPA.0000000000000995
Campa D, Felici A, Corradi C, et al. Long or short? Telomere length and pancreatic cancer and its precursor lesions, a narrative review. Mutagenesis. 2025;40(1):39-47. doi:10.1093/mutage/gead034
Sexton RE, Uddin MH, Bannoura S, et al. Connecting the Human Microbiome and Pancreatic Cancer [published correction appears in Cancer Metastasis Rev. 2022 Jun;41(2):333. doi: 10.1007/s10555-022-10037-3.]. Cancer Metastasis Rev. 2022;41(2):317-331. doi:10.1007/s10555-022-10022-w

Introduction

Intraductal papillary mucinous neoplasms (IPMN) is one of the main pancreatic ductal adenocarcinoma precursors, characterized by a remarkable morphological and spatial heterogeneity. This phenotypical heterogeneity is reflected in IPMN prognosis, with gastric phenotype IPMNs being more often branch-duct and low-grade lesions. There is no biomarker to predict which lesion will progress, complexifying the clinical surveillance scheme. Infiltration of immune cells and fibroblasts in tumor microenvironment (TME) may play a role in this phenotypic heterogeneity.

Aims & Methods

The aim of the present study was to describe the molecular heterogeneity of IPMN lesions at a transcriptional level and their TME. All histological slides from 135 paraffin embedded (FFPE) surgical pancreatic resections for IPMN (2013-2023) were reviewed for selection of regions of morphological interest (ROI) depending on IPMN phenotype and dysplasia. A total of 420 morphologically homogeneous ROI were microdissected for RNA sequencing and 22 from mixed phenotype for DNA sequencing. Additionally, 127 regions adjacent to IPMN lesions were annotated for immunochemistry to quantify immune cell and fibroblast infiltration. Proliferation index was quantified for all microdissections by Ki67 immunostaining.

Results

Among the 135 resections, 49 (36%) were pure gastric, 54 (40%) pure intestinal, 6 (4%) pure pancreatobiliary (PB) and 26 (19%) displayed a mixed phenotype (2 or 3 different phenotypes within the same specimen). Out of the 420 microdissections, 181 were gastric (22% high grade), 195 intestinal (40% high grade) and 44 PB (all high grade). Unsupervised analysis showed an important overlap of gastric and PB phenotype in contrast with intestinal IPMNs. Samples from mixed phenotypes tended to cluster independently and 8 out of 22 showed a common clonal origin. In non-intestinal samples, HG lesions clustered in 2 groups, one purely composed of gastric phenotype and a distinct one composed of gastric and PB. In intestinal samples, HG samples poorly clustered suggesting a biological continuum. Indeed, genes overexpressed in intestinal samples were enriched for cell division and proliferation pathways and the ki67 was significantly higher in intestinal (mean 24% ± 16) compared to gastric samples (mean 6% ± 6.4, p<0.0001). Overexpressed genes in gastric samples were highly enriched in immune response pathways. In fact, TME CD4 and CD8 T cell infiltration was significantly higher in gastric and PB compared to intestinal samples and this, independently of grade of dysplasia. Yet, PB samples displayed a significantly higher TME infiltration of active fibroblasts, regulatory T cells, M2 macrophages and neutrophils compared to gastric and intestinal phenotypes.

Conclusion

Our findings highlight the transcriptomic and microenvironmental heterogeneity of IPMN phenotypes, with distinct molecular programs and immune landscapes associated with each subtype. While intestinal IPMN are characterized by a proliferative, immune-cold profile irrespective of dysplasia grade, gastric and PB lesions show marked immune infiltration, with PB lesions enriched in immunosuppressive cell populations. These results suggest that TME composition may contribute to the differential progression potential of IPMN subtypes and provide a rationale for phenotype-specific biomarkers and interception strategies.

Introduction

Surgery is the traditional treatment of traumatic pseudocysts, but with considerable morbidity and mortality. A minimally invasive management of these collections has been increasingly used. Objective: To analyze the outcome following endoscopic treatment of pancreatic pseudocysts caused by abdominal trauma and to study the integrity of the main pancreatic duct (MPD).

Aims & Methods

Patients with pancreatic fluid collections due to abdominal trauma and who underwent endoscopic therapy were studied. All were symptomatic with a persistent collection for more than 6 weeks. Opacification of the MPD allowed characterization according to Takishima Classification (I, II and III) which guided therapy. Endoscopic drainage was divided into: transpapillary (Takishima II and III without bulging), transmural (type I) or combined (type II or III with bulging).

Results

From January 2020 January 2025 51 patients (36 men, mean age of 35.2 years, range - 13.9 years) were identified who developed pancreatic collections after blunt or penetrating abdominal trauma., The average size of the collection was 14.3  5.2 cm. ERP was obtained in 47/51 (90%). Drainage was transmural in 13 (all type I), combined in 24 (type IIa (4), IIb (7) and III (13) and transpapillary in 10 (all type III without bulging). The remaining 4 were drained transmurally. The success of endoscopic treatment was 94% with a recurrence rate of 8%. Stent occlusion occurred in 6%. There were 9 complications, but no procedural-related deaths. Patients with penetrating trauma had more recurrences than those with blunt trauma (p = 0.01). Penetrating trauma conferred a relative risk for development of infection 0.25; (95% 0.07 - 0.88; p = 0.045).

Conclusion

Endoscopic treatment of pancreatic fluid collections that develop after pancreatic trauma is safe and effective and can be considered a first-choice alternative to surgical and/or percutaneous treatment. Pancreatography is useful in determining the best endoscopic approach.

Disclosure

​NO CONFLICT OF INTEREST

Introduction

The diagnosis of non-calcific chronic pancreatitis (CP) is challenging due to the limited accuracy of available diagnostic methods. Endoscopic ultrasound (EUS) is currently considered the most accurate method for the diagnosis of the disease, but age-related changes may affect this accuracy. In this setting, EUS-guided elastography may play a relevant role by quantifying the degree of pancreatic fibrosis, thus optimizing the diagnostic accuracy of the technique.

Aims & Methods

The aim of our study was to evaluate whether EUS-guided elastographic evaluation of the pancreas in patients with suspected CP is affected by patient age.
METHODS: Prospective comparative study of patients undergoing EUS-guided elastography for the evaluation of non-calcific CP. Procedures were performed with Fujifilm linear echoendoscopes attached to the Arietta 850 ultrasound system. The number of EUS criteria for CP according to the Rosemont classification was evaluated. The degree of pancreatic fibrosis was quantified by measuring the strain histogram (SH) and strain ratio (SR). For the evaluation of SH, an area of the pancreatic body was selected, and for the analysis of SR, the same area was selected (area A), and a soft extrapancreatic area was selected as a reference (B), with the quotient B/A being the result. Data are presented as mean ± standard deviation or median and range for quantitative variables and as percentages for categorical variables. Associations between categorical variables were tested using Fisher's exact test or chi-squared test, as appropriate. Quantitative variables were analyzed by ANOVA, and the correlation between SH and SR with Rosemont classification was analyzed by logistic regression. The Spearman test was used to assess the correlation between non-parametric variables.

Results

The study included 284 patients with a mean age of 49.8 years (range 17-85), 142 males. Normal pancreas on EUS was described in 43 patients (15.1%), indeterminate changes for CP in 110 (38.7%), and suggestive findings for CP in 131 (46.1%) according to the Rosemont classification. A statistically significant positive correlation was found between age and the number of EUS criteria according to the Rosemont classification for CP, regardless of etiology (r=0.127, p=0.03), as well as in patients without risk factors (idiopathic CP) (r=0.383, p=0.008). However, no significant correlation was observed between age and EUS elastography (neither SR nor SH) in any of the patient groups.

Conclusion

The evaluation of pancreatic fibrosis by EUS-guided elastography is not influenced by the age of the patients and is therefore accurate for the evaluation of CP.

Disclosure

Julio Iglesias-Garcia, international advisor for Fujifilm, Boston-Scientific, Viatris
Yessica Dominguez-Novoa, international advisor for Fujifilm, Viatris
Jose Lariño-Noia, international advisor for Fujifilm, Boston Scientific, Viatris
J. Enrique Domínguez, international advisor for Boston Scientific, Viatris