Enhancing Comprehensive Genome Profiling of Liver Tumors Using Endoscopic Ultrasound-Guided Fine-Needle Biopsy

Background/study aim: Comprehensive genome profiling (CGP) is gaining importance in the management of biliary and pancreatic cancers; therefore, obtaining ideal tissue samples is critical. Although percutaneous biopsy has been the first-line method of sampling liver tumors, recent advancements in endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA), particularly the introduction of fine-needle biopsy (FNB) needles capable of obtaining larger tissue samples, suggest that EUS-TA may be an alternative for obtaining ideal specimens for CGP. However, few studies have evaluated the utility of EUS-TA with CGP for liver tumors. This study aimed to assess the role of EUS-guided FNB (EUS-FNB) in the collection of ideal liver tumor samples for CGP and analyses. Patients and Methods: This retrospective study included 36 patients with liver tumors who underwent EUS-FNB. The histological diagnostic accuracy, rate of obtaining ideal samples for CGP, and impact of procedural factors, such as needle gauge, tumor size, and number of punctures, were analyzed. Results: EUS-TA achieved a histological diagnostic accuracy rate of 94.4%, and the rate of obtaining ideal samples for CGP was 63.9%. A subgroup analysis showed that 22-gauge (70.4%) and 19-gauge (100%) needles were significantly more effective than 25-gauge needles (16.7%) for obtaining ideal samples for CGP (P = 0.025 and P = 0.048, respectively). No adverse events were observed during or after sampling. Conclusions: EUS-FNB is highly effective for obtaining ideal samples for CGP and achieving an accurate histological diagnosis. The 22-gauge and 19-gauge needles were significantly superior to 25-gauge needles, thus emphasizing their importance in precision medicine.