Endoscopic Ultrasound-Guided Tissue Acquisition of Pancreatic Solid Tumors

Endoscopic ultrasound-guided tissue acquisition for pancreatic solid tumors has become essential in diagnostic practice. Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has demonstrated high diagnostic accuracy, its cytology-based samples often limit histologic evaluation, immunohistochemistry, and molecular testing. To overcome these limitations, end-cutting fine-needle biopsy (EUS-FNB) needles-notably Franseen and fork-tip designs-were developed to obtain well-preserved core tissue. These needles improve diagnostic accuracy, tissue adequacy, and sampling efficiency compared with FNA or reverse-bevel devices. Technical refinements have also improved outcomes. Fanning and torque maneuvers enhance tissue sampling across heterogeneous tumors, while aspiration strategies such as slow-pull, wet suction, and heparinized wet suction optimize core tissue preservation and reduce blood contamination. Macroscopic on-site evaluation confirms specimen adequacy, often reducing required needle passes without cytopathology support. Although generally safe, endoscopic ultrasound-guided sampling may cause bleeding, infection, pancreatitis, or rare needle-tract seeding. Careful needle selection, minimizing needle passes, and attention to anatomical relationships are crucial to mitigating these risks. Current evidence does not support routine prophylactic antibiotic use for solid lesions. As precision oncology increasingly relies on molecular profiling and next-generation sequencing, reliable procurement of high-quality tissue has become more important. This review summarizes advances in needle design, sampling techniques, on-site evaluation, antibiotic considerations, and complication management in endoscopic ultrasound-guided tissue sampling of pancreatic solid tumors.