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Prospective randomized comparison of a 22G core needle using standard versus capillary suction for EUS-guided sampling of solid pancreatic masses.

ABSTRACT: BACKGROUND AND STUDY AIMS:?The optimal technique for sampling pancreatic lesions with a 22?G Procore needle (pc) is unknown. The aims of this study were to evaluate the 22?Gpc using standard suction technique (SST) and capillary suction technique (CST) and compare diagnostic adequacy of 22?Gpc with the standard 25?G needle. PATIENTS AND METHODS:?Sixty consecutive patients referred for EUS-FNA of a solid pancreatic mass were prospectively evaluated. All patients underwent 2 passes with a standard 25?G needle for cytologic analysis. The first group of 30 patients underwent a single pass with the 22?Gpc needle using SST for cytology and histology. The second group underwent a single pass with the 22?Gpc needle using CST. The sequence of passes was randomized. The diagnostic adequacy of each pass was graded by 2 cytopathologists blinded to technique and needle type for comparison. RESULTS:?For a cytologic diagnosis with 22?Gpc, an adequate sample was obtained in 82.8?% SST vs. 80.0?% CST ( P ?=?0.79). For a histologic diagnosis with 22?Gpc, an adequate sample was obtained in 70.4?% SST vs. 69.0?% CST ( P ?=?0.91). A single pass with 22?Gpc provided comparable results to a single pass with the 25?G needle for a cytologic diagnosis; both were superior to a single 22?Gpc pass for a histologic diagnosis. Two passes with the 25?G needle provided a diagnostic specimen in 95.0?% vs 81.4?% with one pass using 22?Gpc ( P ?=?0.01). CONCLUSIONS:?No significant difference in diagnostic adequacy was observed between techniques for the 22?Gpc. Two passes with a 25?G needle performed better than 1 pass with 22?Gpc. (NCT01598194).

SUBMITTER: Weston BR

PROVIDER: S-EPMC5462609 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Prospective randomized comparison of a 22G core needle using standard versus capillary suction for EUS-guided sampling of solid pancreatic masses.

Weston Brian R BR Ross William A WA Bhutani Manoop S MS Lee Jeffrey H JH Pande Mala M Sholl Andrew B AB Krishnamurthy Savitri S

Endoscopy international open 20170607 6

<h4>Background and study aims</h4> The optimal technique for sampling pancreatic lesions with a 22 G Procore needle (pc) is unknown. The aims of this study were to evaluate the 22 Gpc using standard suction technique (SST) and capillary suction technique (CST) and compare diagnostic adequacy of 22 Gpc with the standard 25 G needle.<h4>Patients and methods</h4> Sixty consecutive patients referred for EUS-FNA of a solid pancreatic mass were prospectively evaluated. All patients underwent 2 passes ...[more]

PMID: 28596983

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Project description:Background and aimsAlthough conventional EUS-guided FNA (EUS-FNA) has previously been considered first-line for sampling subepithelial lesions (SELs), variable accuracy has resulted in increased use of fine-needle biopsy (FNB) sampling to improve diagnostic yield. The primary aim of this study was to compare FNA versus FNB sampling for the diagnosis of SELs.MethodsThis was a multicenter, retrospective study to evaluate the outcomes of EUS-FNA and EUS-guided FNB sampling (EUS-FNB) of SELs over a 3-year period. Demographics, lesion characteristics, sensitivity, specificity, accuracy, number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell block accuracy, and adverse events were analyzed. Subgroup analyses were performed comparing FNA versus FNB sampling by location and diagnostic yield with or without ROSE. Multivariable logistic regression was also performed.ResultsTwo hundred twenty-nine patients with SELs (115 FNA and 114 FNB sampling) underwent EUS-guided sampling. Mean patient age was 60.86 ± 12.84 years. Most lesions were gastric in location (75.55%) and from the fourth layer (71.18%). Cell block for FNB sampling required fewer passes to achieve conclusive diagnosis (2.94 ± 1.09 vs 3.55 ± 1.55; P = .003). The number of passes was not different for ROSE adequacy (P = .167). Immunohistochemistry was more able to be successfully performed in more FNB sampling samples (69.30% vs 40.00%; P < .001). Overall, sensitivity and accuracy were superior for FNB sampling versus FNA (79.41% vs 51.92% [P = .001] and 88.03% vs 77.19% [P = .030], respectively). On subgroup analysis, sensitivity and accuracy of FNB sampling alone was superior to FNA + ROSE (79.03% vs 46.67% [P = .001] and 87.25% vs 68.00% [P = .024], respectively). There was no significant difference in diagnostic yield of FNB sampling alone versus FNB sampling + ROSE (P > .05). Multivariate analysis showed no predictors associated with accuracy. One minor adverse event was reported in the FNA group.ConclusionsEUS-FNB was superior to EUS-FNA in the diagnosis of SELs. EUS-FNB was also superior to EUS-FNA alone and EUS-FNA + ROSE. These results suggest EUS-FNB should be considered a first-line modality and may suggest a reduced role for ROSE in the diagnosis of SELs. However, a large randomized controlled trial is required to confirm our findings.

Dataset Information

Prospective randomized comparison of a 22G core needle using standard versus capillary suction for EUS-guided sampling of solid pancreatic masses.

Publications

Prospective randomized comparison of a 22G core needle using standard versus capillary suction for EUS-guided sampling of solid pancreatic masses.

Similar Datasets

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