Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle

Varadarajulu, Shyam; Bang, Ji Young; Hébert‐Magee, Shantel

doi:10.1016/j.gie.2012.04.455

Cited by 103 publications

(99 citation statements)

References 18 publications

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“…Furthermore, 25 G needles were superior to 22 G needles for diagnosing mobile small lesions. A histologic yield of 95% using this needle was similar to the 90% achieved in EUS-FNB using 19 G Pro-Core (Cook Endoscopy, Wilson-Salem, NC, USA) needles [26]. EUS-FNA with an on-site cytopathologist (rapid on-site cytopathological examination) resulted in a 10-29% increase in the adequacy rates of EUS-FNA specimens and a 10-15% increase in the diagnostic rate [27,28].…”

Section: Endoscopic Ultrasoundsupporting

confidence: 59%

“…However, EUS findings are not sufficient to accurately predict malignancy [10]. If tissue was obtained from EUS-guided fine-needle aspiration (EUS-FNA), the diagnostic accuracy increased markedly, ranging from 63 to 98% [1,[26][27][28]. EUS-FNA for SETs using a forward-viewing linear EUS has provided good results: full histologic assessment rate of 93.4%, sensitivity of 92.8%, specificity of 100% [20,42].…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

See 1 more Smart Citation

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Al-Lehibi¹,

Bamakhrama²

2017

Endoscopic Ultrasound - From Usual to Special

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A subepithelial lesion (SET) is defined as a lesion, bulge or impression visible within the lumen of the gastrointestinal tract that is covered by normally appearing mucosa and usually found incidentally during routine endoscopy. Such a lesion could be either an intramural mass or an impression caused by extramural structures. The old terminology has recently been replaced by the term "subepithelial lesion" because intramural lesions may arise and can be located in any layer of the GI wall underneath the epithelium. The most common SELs are gastrointestinal stromal tumors (GISTs), leiomyomas, lipomas, granular cell tumors (GCTs), pancreatic rests and carcinoid tumors. The prognosis varies from benign to potentially malignant. While the majority of the lesions are considered benign, some tumors such as GISTs and carcinoids have a strong propensity for malignant transformation. Endoscopic ultrasonography (EUS) is the most accurate diagnostic method for distinguishing between extraluminal compressions and intramural lesions and plays a critical role in the detection and management of SELs. This is because EUS can reveal the precise sonographic nature of the lesion even though sometimes there are complex cases, which are difficult to diagnose by EUS alone. Performing routine biopsies and obtaining tissue samples for diagnosis can be difficult because SELs are located beneath the normal epithelial layer. Mostly, EUS allows the practitioner to extract an optimal tissue sample since it allows fine-needle aspiration (FNA) and fine-needle biopsy (FNB) both of which provide good results. With immunocytochemical staining, all these techniques increase the accuracy of the diagnosis. Evaluation of subepithelial lesions by means of EUS imaging will provide further characterization of the lesion to help guide us in appropriate differential diagnosis and further management. In this chapter, we provide a systematic EUS-guided approach to the diagnosis, management and later surveillance for SELs, as well as presenting updated diagnostic techniques that may help physicians to appropriately manage these subepithelial lesions.

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Section: Endoscopic Ultrasoundsupporting

confidence: 59%

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Al-Lehibi¹,

Bamakhrama²

2017

Endoscopic Ultrasound - From Usual to Special

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“…Yasuda et al [8] demonstrated that 88% of the 152 patients diagnosed with lymphoma were able to be classified in accordance with the World Health Organization (WHO) system. Furthermore, a recent study that examines the role of a flexible 19-G EUS needle showcased the added benefit of a flexible needle in reaching target lesions that were otherwise difficult to reach by the same caliber of needle [9] . In the same study, in a cohort of 38 patients, the group was able to procure 100 and 95% satisfactory specimens for cytology and histology assessment, respectively.…”

Section: Introductionmentioning

confidence: 99%

Flexible 19-Gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Needle: First Experience

Tyan

Patel²,

Czarnecka³

et al. 2017

Respiration

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established first-line invasive modality for mediastinal lymph node staging in lung cancer patients and in the diagnostic workup of patients with mediastinal adenopathy. With the current 21- and 22-gauge (G) EBUS-TBNA needles, the procedure can be limited by the degree of flexibility in the needle and the size of the lumen in tissue acquisition. Objective: We report our initial experience with a first-generation flexible 19-G EBUS-TBNA (Flex 19G; Olympus Respiratory America, Redmond, WA, USA) needle with regards to efficacy and safety. Methods: The Flex 19G EBUS-TBNA needle was used in 47 selected patients with enlarged hilar and/or mediastinal lymphadenopathy at 3 centers. The standard Olympus EBUS scope with a 2.2-mm working channel was used in all cases. Results: The diagnostic yield of the Flex 19G needle according to clinical cytopathology reports was 89% (42/47). The diagnosis and their respective diagnostic yield with the Flex 19G EBUS-TBNA needle were malignancy 24/27 (89%), sarcoidosis 13/14 (93%), and reactive lymph node hyperplasia 5/6 (83%). The mean short axis of the sampled lymph nodes was 19 ± 9 mm. No complications occurred except for 1 instance of moderate bleeding, which did not require intervention beyond suctioning and subsequently resolved. All 13 patients diagnosed with adenocarcinoma by the 19-G needle had sufficient tissue for genetic testing. Conclusion: EBUS-TBNA using the first-generation Flex 19G needle is feasible and safe with promising diagnostic yield while providing a greater degree of flexion with the Olympus EBUS scope. Additional clinical evaluations are warranted.

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“…Other studies that have evaluated the 19G needle for tissue acquisition report no adverse events associated with its use. [6][7][8]12 In a recent meta-analysis that compared the 19G versus 22G/25G needles for EUS-FNA of solid pancreatic mass lesions, there was no difference in the rates of complications between the 2 cohorts. 18 There are several limitations to our study.…”

Section: Discussionmentioning

confidence: 99%

“…5 Although a larger 19G needle can procure histological samples, published data are limited. [6][7][8] In a study of 120 patients who underwent EUS-FNA using the 19G needle, the procedure was technically successful in 98.9%, and adequate histological sample was obtained in 97.5%. 6 However, patients with pancreatic head or uncinate masses were excluded in this study.…”

mentioning

confidence: 99%

Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions

2016

Pancreas

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Objectives: Although a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), its advantage over smaller needles is unclear. This study compared flexible 19G and 25G needles for EUS-FNA of solid pancreatic masses.Methods: This was a randomized trial of patients undergoing EUS-FNA of pancreatic masses using flexible 19G or 25G needle. Main outcome measure was to compare median number of passes for on-site diagnosis. Secondary measures were to compare specimen bloodiness, complications, technical failures, and histological core tissue procurement.Results: One hundred patients were randomized to EUS-FNA using flexible 19G or 25G needle. Median of 1 pass was required to achieve on-site diagnosis of 96% and 92% (P = 0.68) in 19G and 25G cohorts. There was no significant difference in technical failure (0% vs 2%, P = 0.99) or adverse events (2% vs 0%, P = 0.99) between 19G and 25G cohorts. Although histological core tissue procurement was significantly better with flexible 19G needle (88% vs 44%, P < 0.001), specimens were bloodier (severe bloodiness, 36% vs 4%; P < 0.001). Conclusions:As there is no significant difference in the performance of flexible 19G and 25G needles, needle choice for sampling pancreatic masses should be based on endoscopist preference and need for histology.Key Words: EUS-FNA, solid pancreatic mass, pancreatic cancer, pancreatic biopsy, flexible 19G needle, randomized trial (Pancreas 2015;44: 128-133) E ndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an integral part of the diagnostic algorithm for the evaluation of solid pancreatic mass lesions. Randomized trials have compared the 25G, 22G, and 19G needles in an attempt to identify the optimal needle for tissue acquisition.1-3 Of the 3 studies that compared the 22G and 25G needles, 1-3 whereas there was no significant difference in diagnostic accuracy, there was a trend toward better performance with the 25G needle for the FNA of pancreatic head masses. These findings were confirmed in a recent meta-analysis that revealed higher sensitivity of 25G over 22G needles for the EUS-FNA of pancreatic mass lesions. 4A limitation of FNA procedures, particularly when using smaller gauge (22G or 25G) needles, is the limited ability to procure adequate histological samples. Tissue architecture and morphology are essential for accurate pathological assessment of certain lesions, such as lymphomas and gastrointestinal stromal tumors, for which histological core is preferred over a cytological aspirate. 5 Although a larger 19G needle can procure histological samples, published data are limited.6-8 In a study of 120 patients who underwent EUS-FNA using the 19G needle, the procedure was technically successful in 98.9%, and adequate histological sample was obtained in 97.5%. 6 However, patients with pancreatic head or uncinate masses were excluded in this study. A major limitation of the 19G needle has been its rigidity that makes transduodenal sampling of pancreatic masses difficult beca...

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Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle

Cited by 103 publications

References 18 publications

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Role of Endoscopic Ultrasound in Subepithelial Lesions (SELs)

Flexible 19-Gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Needle: First Experience

Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions

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