Pancreatic cancer is the third leading cause of cancer related mortality, and early diagnosis remains essential to enable potentially curative resection. Although histopathology is the diagnostic standard, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has emerged as the preferred method for tissue acquisition. Our aim was to evaluate whether on-site assessment techniques, specifically rapid on-site evaluation (ROSE) and macroscopic on-site evaluation (MOSE), can enhance sample adequacy and reduce the need for repeat biopsy during EUS-guided tissue acquisition. 

We performed a retrospective analysis of 95 consecutive patients undergoing EUS-guided tissue acquisition at the institute of Pancreatic Diseases, Semmelweis University, between September and December 2024. Outcomes assessed included technical success, the impact on ROSE and MOSE on tissue adequacy, re-biopsy rates, and procedure-related adverse events.

Among 95 patients (55% male, 45% female), the technical success rate was 97.25%. ROSE was performed in 69 cases, yielding 100% diagnostic positivity with a mean of 2.15 needle passes. MOSE was used in 73 cases. Re-biopsy rates were 13.4% for ROSE and 17.7% when both techniques were applied. MOSE alone demonstrated a re-biopsy rate of 14.3%. The overall adverse event was 2.78%.

In our single-center experience, MOSE demonstrated performance comparable to ROSE and appears to be a reliable option in settings where ROSE availability is limited.