EUS-guided fine-needle biopsy versus fine-needle aspiration for histopathological evidence for type 1 autoimmune pancreatitis: A single-center retrospective study in China

EUS is recommended for guiding pancreatic tissue acquisition in suspected autoimmune pancreatitis (AIP) cases. However, there is a lack of comparative research on the effectiveness between EUS-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing AIP in China. This study aimed to evaluate the diagnostic accuracy of EUS-guided tissue acquisition (EUS-TA) specifically for type 1 AIP. Between 2010 and 2023, individuals with AIP who received EUS-TA at Changhai Hospital were included in the study. A total of 173 patients diagnosed with AIP who underwent EUS-TA were included in the final analysis. Of these, 104 patients (60.1%) received EUS-FNA, and 69 patients (39.9%) underwent EUS-FNB. Sufficient pancreatic tissue samples (>5 cells/high-power field) were obtained in 164 of 173 patients (94.8%), with success rates of 94.2% for EUS-FNA and 95.7% for EUS-FNB ( 0.05). EUS-FNB exhibited higher rates of reliable level 1 histopathological findings (40.9% 16.3%, < 0.001) and reliable level 2 histopathological findings (33.3% . 12.2%, < 0.001) compared with EUS-FNA. Furthermore, a higher occurrence of IgG4-positive plasma cell infiltration (>10 cells/high-power field) was observed with EUS-FNB compared with EUS-FNA (74.2% . 27.9%, < 0.001). The multivariate logistic analysis also revealed that EUS-FNA was less effective in obtaining reliable evidence compared with EUS-FNB, as evident in both level 2 ( = 0.002; odds ratio, 0.21; 95% confidence interval, 0.08-0.56) and level 1 ( = 0.001; odds ratio, 0.19; 95% confidence interval, 0.08-0.49) histopathological evidence. EUS-FNB demonstrates higher rates of level 1 and level 2 histopathological findings, as well as more abundant IgG4-positive plasma cell infiltration, compared with EUS-FNA.