Introduction
The concept of Macroscopic on-site evaluation (MOSE) was introduced in 2015 when the endoscopist observed better diagnostic yield when the macroscopically visible core on MOSE was superior to 4 mm. Few studies have assessed the adequacy of histologic cores in MOSE during endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS- FNA/FNB). Recently, some classifications were published.
Aims & Methods
Our study aimed to evaluate the MOSE of EUS-FNA/FNB using 2 classifications to determine the adequacy of the histologic core specimens.
This multicentric prospective study conducted in 5 centers in 2 countries (Egypt and Morocco) included 312 patients with pancreatic, biliary, or gastrointestinal pathology who were referred for EUS examination. Data from patients with MOSE evaluation of the specimen were collected.
Results
The mean age of the 312 patients was 60 ± 12 years and 172 patients (55%) were males. The mean lesion size was 38.2 ± 18.7 mm. 323 lesions were biopsied, of which 213 were pancreatic lesions (62%). Needle types used were Franseen (Acquire) (n=258, 82.7%) and Procore (n=6, 2%) needles for EUS-FNB and Expect (n=28, 9%) and Echotip (n=20, 6.4%) needles for EUS-FNA. The needle sizes used during the procedures were 22G (95.8%), 20G (2%), and 19G (2.2%). The median number of needle passes was 1.76 [1, 4]. 305 of 312 samples (97.8%) were considered adequate for histological evaluation by the endoscopist. 3 patients presented small blood collection (1%). The overall diagnostic yield of cytopathology was 95%. The cytological examination confirmed the diagnosis of adenocarcinoma in 147 patients (64.2%).
Conclusion
MOSE in EUS-FNA/FNB sampling showed high diagnostic yield and accuracy using different needle sizes. In our study, MOSE helped the endoscopist to improve the quality of the core and, if necessary, to multiply the needle passes. This resulted in a high diagnostic yield for cytopathology.
References
1- Iwashita T, Yasuda I, Mukai T, Doi S, Nakashima M, Uemura S, Mabuchi M, Shimizu M, Hatano Y, Hara A, Moriwaki H. 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: 177-185 [PMID: 25440688 DOI: 10.1016/j.gie.2014.08.040]
2- Gaia S, Rizza S, Bruno M, Ribaldone DG, Maletta F, Sacco M, Pacchioni D, Rizzi F, Saracco GM, Fagoonee S, De Angelis CG. Impact of Macroscopic On-Site Evaluation (MOSE) on Accuracy of Endoscopic Ultrasound-Guided Fine-Needle Biopsy (EUS-FNB) of Pancreatic and Extrapancreatic Solid Lesions: A Prospective Study. Diagnostics (Basel) 2022; 12 [PMID: 35204519 DOI: 10.3390/diagnostics12020428]
3- Mangiavillano B, Frazzoni L, Togliani T, Fabbri C, Tarantino I, De Luca L, Staiano T, Binda C, Signoretti M, Eusebi LH, Auriemma F. Macroscopic on-site evaluation (MOSE) of specimens from solid lesions acquired during EUS-FNB: Multicenter study and comparison between needle gauges. Endoscopy International Open. 2021 Jun;9(06):E9
