A Prospective Comparison of EUS-Guided FNA Using 25-Gauge and 22-Gauge Needles

Abstract

Background and Aims. There are limited data on the differences in diagnostic yield between 25-gauge and 22-gauge EUS-FNA needles. This prospective study compared the difference in diagnostic yield between a 22-gauge and a 25-gauge needle when performing EUS-FNA. Methods. Forty-three patients with intraluminal or extraluminal mass lesions and/or lymphadenopathy were enrolled prospectively. EUS-FNA was performed for each mass lesion using both 25- and 22-gauge needles. The differences in accuracy rate, scoring of needle visibility, ease of puncture and quantity of obtained specimen were evaluated. Results. The overall accuracy of 22- and 25-gauge needle was similar at 81% and 76% respectively (N.S). Likewise the visibility scores of both needles were also similar. Overall the quantity of specimen obtained higher with the 22-gauge needle (score: 1.64 vs. P < .001). However the 25-gauge needle was significantly superior to the 22-gauge needle in terms of ease of puncture (score: 1.9 vs. 1.29, P < .001) and in the quantity of specimen in the context of pancreatic mass EUS-FNA (score: 1.8 vs. 1.58, P < .05). Conclusion. The 22-gauge and 25-gauge needles have similar overall diagnostic yield. The 25-gauge needle appeared superior in the subset of patients with hard lesions and pancreatic masses.

Clinical Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis of Mediastinal and Intra-Abdominal Lymphadenopathy

“…Therefore, the most commonly used needles for diagnostic FNA are 22 or 25 gauge, but the optimal needle size continues to be controversial. Imazu et al [21] carried out a prospective comparison of EUS-guided FNA using 22- and 25-gauge needles and concluded that both had a similar overall diagnostic yield. Most studies appear to have used a 22-gauge needle, and we were also able to obtain sufficient material for cytopathology using 22-gauge needles in 96% of our patients, although we did use 25-gauge needles early on in our experience.…”

Pancreatic Sampling by Endoscopic Ultrasound–Guided Fine-Needle Aspiration and Needle Biopsy From the Cytopathology Perspective

“…7 Interestingly, several prospective studies specifically assessing this issue did not demonstrate a significant difference in the yield of tissue or diagnostic accuracies between the 22-and 25-gauge needles when used for EUS-FNA sampling of intra-abdominal masses, including solid pancreatic masses. 11,12,14 Yet, there are also other studies that have shown a trend, albeit nonsignificant, toward higher overall diagnostic yield when solid pancreatic masses were sampled with a 25-gauge needle. 11,12,15 The proposed rationale for these observations is that the 25-gauge EUS-FNA needle acquires more cellular, less bloody aspirates with less tissue trauma, and the flexibility of the needle is better suited for sampling pancreatic lesions in the head or uncinate process.…”

“…Currently, there is no consensus as to which needle gauge provides the best diagnostic yield; however, the factors to consider in choosing a needle and the potential effects on the subsequent specimen obtained are summarized in Table 2 comparing smaller-and larger-gauge needles. 11,12 In general, the larger 19-gauge FNA needles may acquire larger amounts of tissue and thus have the potential to improve sample quality and diagnostic accuracy with fewer needle passes. However, several studies have demonstrated more technical failures with the 19-gauge needle device, mostly due to the difficulty of passing the needle through the EUS working channel and increased needle stiffness when attempting to angle the needle into pancreatic lesions.…”

How to improve the success of endoscopic ultrasound guided fine needle aspiration cytology in the diagnosis of pancreatic lesions

“…24,25 Currently, seven comparative studies are available in the literature comparing 22 G and 25 G needles. [24][25][26][27][28][29][30] Four are randomized controlled studies (RCT) ( Table 1). 25,29,30 In general, available RCT have not found significant differences between both needles, but suggest that 25 G could be better in very fibrotic lesions and those located in the head or uncinate process of the pancreas.…”