Abstract
BACKGROUND: Pancreatic cancer is highly lethal and often diagnosed at an advanced stage, highlighting the need for early and accurate diagnosis. Although imaging plays a crucial role, definitive pathological confirmation requires biopsy. Percutaneous ultrasound-guided core needle biopsy (US-CNB), computed tomography-guided core needle biopsy (CT-CNB), and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are the three main biopsy techniques, each differing in diagnostic accuracy, safety, and cost-effectiveness. The aim of this study was to compare the diagnostic value, safety, and cost-effectiveness of these three biopsy techniques for suspiciously malignant pancreatic lesions. METHODS: We retrospectively evaluated patients with suspicious malignant pancreatic lesions who underwent US-CNB, CT-CNB, or EUS-FNA from January 2018 to January 2023. We compared technical success rates, sample adequacy, diagnostic accuracy, sensitivity, specificity, and complication rates of three groups. Additionally, we calculated the cost/effectiveness ratio (C/E) and incremental cost-effectiveness ratio (ICER) for each method. RESULTS: A total of 399 patients were enrolled (US-CNB, n=86; CT-CNB, n=55; EUS-FNA, n=258), achieving 100% technical success. Sample adequacy satisfaction rates were 97.70% for US-CNB, 90.90% for CT-CNB, and 74.03% for EUS-FNA, with EUS-FNA significantly lower compared to the other two methods (P<0.001). Diagnostic accuracy was significantly higher for US-CNB (97.70%) and CT-CNB (90.90%) compared to EUS-FNA (69.80%) (P<0.001). Complication rates were 15.12% for US-CNB, 16.36% for CT-CNB, and 10.47% for EUS-FNA, with no significant differences (P=0.319). Compared to EUS-FNA, ICER for US-CNB was -14,367.7 yuan and for CT-CNB was -8,279.22 yuan per correct diagnosis, both below the willingness-to-pay threshold. CONCLUSIONS: US-CNB and CT-CNB demonstrate superior diagnostic accuracy and specimen adequacy compared to EUS-FNA for suspected malignant pancreatic lesions. There are no significant differences in postoperative complication rates among three biopsy methods. In terms of cost-effectiveness, US-CNB and CT-CNB have lower costs and higher effectiveness than EUS-FNA, indicating greater economic efficiency.