Comparison of Endoscopic Ultrasound-Guided Fine Needle Aspiration with 19-Gauge and 22-Gauge Needles for Solid Pancreatic Lesions

Comparation of 5 ml and 10 ml Negative Pressures with Wet-suction Techniques for EUS-FNA of Solid Lesions: A Single-center Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

The negative pressure selectable for the wet-suction technique remains uncertain. The aim was to investigate the quality of sampling and diagnostic accuracy with solid lesions by 5 mL and 10 mL negative pressure with wet-suction techniques.

METHODS

This is a single-center, crossover, randomized controlled trial conducted with a random sampling technique. In all, 160 patients consecutively undergoing EUS-FNA for solid lesions were randomized in a ratio of 1:1 into 2 groups, the 5 mL and 10 mL negative pressure wet-suction group. The main outcome was to compare the sample quality between the 2 groups. The secondary outcome was to compare the histologic and cytologic diagnostic accuracy of solid lesions.

RESULTS

Pancreatic (n=129) and nonpancreatic (n=27) lesions from 156 lesions were examined. The sample quality concluding cellularity, adequacy, integrity, and blood contamination were comparable between the 2 groups. However, in subgroup analysis, we found 19G FNA provided more integrity of specimen in 5 mL than in 10 mL group (100% vs. 82.9%, P =0.025). In contrast, this benefit was not noteworthy in the 22G FNA subgroup. And there was no statistically significant in histologic (87.82% vs. 87.18%, P =1.000) and cytologic (78.85% vs. 80.77%, P =0.778) accuracy between 5 mL and 10 mL groups.

CONCLUSION

When using the wet-suction technique, 5 mL and 10 mL negative pressure offer equivalent sample quality and diagnostic accuracy. However, the 19G FNA can obtain better sample quality with 5 mL negative pressure than 10 mL negative pressure.

Comparing needle types and aspiration techniques in EUS-TA to optimize diagnostic efficacy and specimen quality in patients with pancreatic lesions

Purpose

In solid pancreatic lesions (SPLs), we compared the diagnostic efficacy of a 19G fine-needle aspiration (FNA) needle and a 22G ProCore fine-needle biopsy (FNB) needle, We also compared the specimen quality between the standard suction (SS) technique and heparinized wet-suction (HWS) technique.

Methods

All cases of endoscopic ultrasound-guided tissue acquisition (EUS-TA) by 19G FNA or 22G FNB for SPLs in a single-centre hospital were retrospectively reviewed. The diagnostic yield was compared between the 19G and 22G groups. Univariate and multivariate logistic regression analyses were used to identify optimal factors for a correct histological diagnosis. We also examined tissue integrity, the length of the tissue cores, and the rate of blood cell contamination between the SS and HWS groups.

Results

One hundred seventy-one and sixty-three patients were included in the comparisons of needle types and suction techniques, respectively. The 19G group had higher histological diagnosis rates compared to the 22G group for the first pass (87.8% vs. 70.4%, p = 0.005), the second pass (82.2% vs. 65.4%, p = 0.012), the first two passes (90.0% vs. 72.8%, p = 0.004), and the final diagnosis (91.1% vs. 79%, p = 0.025). Through macroscopic on-site evaluation, a significantly higher proportion of patients in the 22G group required a third needle pass compared to the 19G group (88.9% vs. 67.8%, p = 0.002). The total procedure time was shorter in the 19G group than in the 22G group (p < 0.001). The HWS group showed superiority over the SS group in terms of the total length of tissue cores (p < 0.001) and the total length of white tissue cores (p = 0.005). The HWS group, compared to the SS group, can enhance the tissue integrity (p = 0.024) and reduce blood cell contamination (p = 0.040) during the first needle pass. There was no significant difference in complication rates between the needle puncture groups (p = 0.770) or the aspiration technique groups (p = 0.654).

Conclusion

Compared to the 22G FNB needle, endoscopists should consider using the 19G FNA needle when appropriate. Furthermore, the use of the HWS technique for the first pass is recommended to improve specimen quality.

Comparison of 19G FNA Versus 22G FNB Needles for Endoscopic Ultrasound-Guided Fine-Needle Sampling of Subepithelial Tumors: Is Bigger Better?

OBJECTIVES

To compare the diagnostic efficiency of 19G fine-needle aspiration (FNA) and 22G fine-needle biopsy (FNB) in endoscopic ultrasound (EUS)-guided sampling for subepithelial tumors (SETs).

METHODS

The data of patients with SETs who underwent 19G FNA or 22G FNB were reviewed retrospectively in two tertiary hospitals. Tissue cores were assessed by macroscopic on-site evaluation (MOSE). Cytological or histological diagnosis were classified as definite, suspect, or no diagnosis.

RESULTS

Seventy five patients (mean age: 55 years, 44 males) underwent 19G EUS-FNA (31) or 22G EUS-FNB (44). The overall diagnostic yield was 82.7%. The rate of definite cytological diagnoses was 9.7% (3/31) in 19G and 13.6% (6/44) in 22G group (x2  = 1.520, P = .468). In terms of MOSE, 19G needle, requiring only two punctures, achieved a higher good tissue core rate than 22G group (100.0% [31/31] versus 84.1% [37/44], x2  = 5.440, P = .020]). For histological diagnosis, the 19G group achieved higher definite rate than the 22G group, 93.6% (29/31) versus 65.9% (29/44) (x2  = 7.957, P = .019) on the first puncture, 90.3% (28/31) versus 63.6% (28/44) (x2  = 7.139, P = .028) on the second puncture, 96.8% (30/31) versus 70.5% (31/44) (x2  = 7.319, P = .026) on both the first and second punctures, and 96.8% (30/31) versus 72.7% (32/44) (x2  = 7.538, P = .023) on all three punctures.

CONCLUSIONS

The 19G EUS-FNA requires only two punctures to achieve better tissue core quality by MOSE and yields a higher rate of histological diagnosis than 22G ProCore needle for SETs. The bigger 19G FNA needle seems to play an important role in the evaluation of SETs.

A prospective randomized noninferiority trial comparing conventional smears and SurePathTM liquid-based cytology in endoscopic ultrasound-guided sampling of esophageal, gastric, and duodenal lesions

BACKGROUND

Several liquid-based cytology (LBC) methods are currently used, but the diagnostic accuracy of each method is not well known. We aimed to compare the diagnostic performance of SurePathTM LBC and conventional smear (CS) cytology in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of esophageal, gastric, and duodenal lesions.

METHODS

As a prospective randomized noninferiority study, patients who needed EUS-FNA due to subepithelial mass in the upper gastrointestinal tract were randomly assigned 1:1 to the LBC and CS groups. Cytologic preparation was carried out using a crossover design where 1 method was used for the first needle-pass sample and another method was used for the second needle-pass sample. The primary outcome was to compare the diagnostic performance between LBC and CS using the final diagnosis as the gold standard.

RESULTS

A total of 87 patients were randomized and 60 patients were analyzed. There were no differences between LBC and CS in diagnostic accuracy (91.7% vs 86.7%, P = .380), sensitivity (97.7% vs 90.7%, P = .169), specificity (76.5% vs 76.5%, P > .99), negative predictive value (92.9% vs 76.5%, P = .225), or positive predictive value (91.3% vs 90.7%, P = .921). The background of LBC was less bloody than that of CSs (5.0% vs 53.3%, P < .001) and the sample preparation time of LBC was shorter than that of CSs (29 ± 7 seconds vs 90 ± 17 seconds, P < .001).

CONCLUSION

In the EUS-FNA of a subepithelial mass in the upper gastrointestinal tract, the diagnostic performance of LBC was not inferior to that of CS. The field of view was better in LBC, because the background was less bloody and necrotic. As LBC is more convenient to perform and takes shorter time, it is expected that it can replace the CS method for EUS-FNA samples.

A case of multiple myeloma with pancreatic involvement diagnosed via endoscopic ultrasound-guided fine needle aspiration

This report highlights the importance of considering multiple myeloma in the differential diagnosis of a pancreatic tumor with bone lesions. sampling not only from the pancreatic lesion but also from bone lesions may reach an accurate diagnosis.