P5665 - S. KAREEM TRAP Score for EUS-FNB-Guided Malignant Tissue Output: Comparison of Pancreatic and Non-Pancreatic Solid Lesions

Shahid Karim, MBBS¹, Samreen Simra, BA¹, Owais Syed, MD², Shanil Kadir, MBBS¹
1Liaquat National Hospital, San Antonio, TX; 2University of Texas Health San Antonio, San Antonio, TX

Introduction: The objective of this study was to compare a scoring system for predicting malignancy during EUS-FNB in pancreatic vs non-pancreatic biopsies.

Methods: This retrospective single-study was conducted at Liaquat-National-Hospital in Karachi, Pakistan. Electronic Medical Records of consecutive pancreatic and non-pancreatic EUS-FNB were collected from January 2019 - July 2024, and excluded incomplete procedures. S.KAREEM-TRAP score was developed using four parameters: Tissue size (T: 1 if >4 mm, 0 if < 4 mm), ROSE (R: 1 if positive, 0 if negative), Age (A: 1 if ≥60 years, 0 if < 60 years), and Needle passes (P: 1 if >2 passes, 0 if ≤2 passes), with a scoring range of 0-4. SPSS version-25 was used for data analysis. Diagnostic metrics for pancreatic and non-pancreatic biopsies were calculated, including sensitivity, specificity, and predictive values with a threshold S.KAREEM TRAP score of ³3. ROC-curves and AUC-values to assess the S.KAREEM-TRAP score’s predictive performance for malignancy.

Results: 154 EUS-FNB cases were analyzed (102/154, 66.2% malignant). Median age was 60 years (IQR: 48-67), male predominance (62.3%). Pancreatic biopsies constituted 58.4% of the cases. Overall, Malignancies were identified in 79.5% of patients aged ≥60 years, 77.8% of those with >2 needle passes, 88.8% of cases with a tissue core size >4 mm, and 94.1% of ROSE-positive cases. For pancreatic lesions, S.KAREEM-TRAP score of ≥3 yielded a sensitivity of 86.36% and specificity of 95.83%. For non-pancreatic lesions, the score demonstrated even sensitivity 94.44%, and specificity 100%.

Discussion: The S.KAREEM-TRAP score may be a valuable tool for predicting higher positive outcomes in EUS-FNB-TA for both pancreatic and non-pancreatic solid-lesions.


Figure: Percentage of benign vs malignant lesions present based on S.KAREEM TRAP score


Figure: Receiver operating characteristic (ROC) curve illustrating utility of S.KAREEM TRAP score as binary classifier for benign vs malignancy. Random classifier with AOC = 0.5 is shown for comparison

Disclosures:
Shahid Karim indicated no relevant financial relationships.
Samreen Simra indicated no relevant financial relationships.
Owais Syed indicated no relevant financial relationships.
Shanil Kadir indicated no relevant financial relationships.

Shahid Karim, MBBS¹, Samreen Simra, BA¹, Owais Syed, MD², Shanil Kadir, MBBS¹. P5665 - S. KAREEM TRAP Score for EUS-FNB-Guided Malignant Tissue Output: Comparison of Pancreatic and Non-Pancreatic Solid Lesions, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.