Comparison of the Diagnostic Yield of the Standard 22-Gauge Needle and the New 20-Gauge Forward-Bevel Core Biopsy Needle for Endoscopic Ultrasound-Guided Tissue Acquisition from Pancreatic Lesions

Fujie, Shinya; Ishiwatari, Hirotoshi; Sasaki, Keiko; Sato, Junya; Matsubayashi, Hiroyuki; Yoshida, Masao; Ito, Sayo; Kawata, Noboru; Imai, Kenichiro; Kakushima, Naomi; Takizawa, Kohei; Ono, Hiroyuki

doi:10.5009/gnl18189

Cited by 19 publications

(22 citation statements)

References 22 publications

(29 reference statements)

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“…To overcome these disadvantages of EUS-FNA, several novel needles have been introduced for EUS-guided fine needle biopsy (EUS-FNB). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Recently, a three-plane symmetric needle with Franseen geometry has been developed for performing EUS-FNB. [15][16][17][18][19][20] While rapid on-site evaluation (ROSE) reportedly increases the diagnostic performance and decreases the number of passes, 21 its role in EUS-FNB is not fully established in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions

et al. 2020

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Background/Aims: Recently, a three-plane symmetric needle with Franseen geometry was developed for endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). In this retrospective study, tissue acquisition per pass was compared between 22-gauge Franseen FNB and standard fine needle aspiration (FNA) needles in patients with solid pancreatic lesions. Methods: Consecutive patients who underwent EUS-FNA or EUS-FNB for solid pancreatic lesions between October 2014 and March 2018 were retrospectively studied. The tissue acquisition rate and the diagnostic performance per session, per pass, and at first pass were compared. Results: A total of 663 passes (300 by the FNB needle and 363 by the standard FNA needle) were performed in 154 patients (71 FNB and 83 FNA). The tissue acquisition rate per session and at first pass in the FNB and FNA groups was 100% and 95% (p=0.13) and 87% and 69% (p=0.007), respectively. The multivariate analysis revealed that among the patients, EUS-FNB (odds ratio, 3.07; p=0.01) was associated with a higher first-pass tissue acquisition rate. While the tissue acquisition rate reached a plateau after the 4th pass with FNA, it reached a plateau after the 2nd pass with FNB. Among the 129 malignant cases, the histological tissue acquisition rate per session was similar (100% and 94%), but the sensitivity by histology alone per session was higher for FNB than for FNA (93% and 73%, p<0.01). Conclusions: The results of our retrospective analysis indicated that compared with a standard FNA needle, a 22-gauge Franseen FNB needle was associated with a higher first-pass tissue acquisition rate.

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Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions

et al. 2020

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“…The frequency of AEs observed following EUS-guided tissue acquisition for solid pancreatic lesions was approximately 0 % to 2 % [14,17,20]. However, there are few reports of AEs for small solid pancreatic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Histological diagnosis is also important to distinguish pancreatic cancer from neuroendocrine neoplasms. Several studies have reported that EUS-FNB is more useful in diagnostic yield than EUS-FNA 13 14 15 16 17 18 19 . However, there are only a few reports on use of EUS-FNB in small solid pancreatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of endoscopic ultrasound-guided tissue acquisition for small solid pancreatic lesions

et al. 2020

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Background and study aims Endoscopic ultrasound (EUS)-guided tissue acquisition is sometimes required to diagnose small solid pancreatic lesions. The aim of this study was to evaluate the diagnostic yield of EUS-guided tissue acquisition for small solid pancreatic lesions and the differences in diagnostic yield among different needles. Patients and method We retrospectively analyzed consecutive patients who had undergone EUS-guided tissue acquisition for solid pancreatic lesions less than 2 cm between November 2012 and June 2019. Three types of needles were evaluated in this study: a 22-gauge fine-needle aspiration (FNA) Lancet needle, a 20-gauge fine-needle biopsy (FNB) Menghini needle with a lateral forward bevel, and a 22-gauge FNB Franseen needle. We evaluated the diagnostic yield and safety of the procedure using these needles. Results We analyzed 160 patients with 163 lesions. The overall sensitivity, specificity, and accuracy were 92.0 %, 100 %, and 92.6 %, respectively. In the histological plus cytological diagnosis, accuracies of the Lancet, Menghini, and Franseen needles were 92.7 %, 97.0 %, and 85.7 %, respectively (P = 0.10). In the histological diagnosis alone, the negative predictive values (NPVs) of the Lancet, Menghini, and Franseen needles were 13.3 %, 53.3 %, and 27.3 %, respectively (P = 0.08). Adverse events occurred in four cases (2.5 %): one postprocedural bleeding, two cases of pancreatitis, and one pancreatic abscess. Conclusions EUS-guided tissue acquisition for small solid pancreatic lesions has a high diagnostic yield and safety. This study suggested a difference in the diagnostic yield of each needle for small solid pancreatic lesions.

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“…EUS-FNA demonstrates a fairly high diagnostic ability (nearly 95% sensitivity and specificity) for solid malignant pancreatic lesions [42,43]. The use of thick core biopsy needles [44] and high-negative-pressure aspiration methods [45] has increased the acquisition rate for obtaining core tissue samples. This, in turn, has enabled the determination of the probable nature of the whole pancreatic mass and even the classification of intermediate inflammatory and neoplastic conditions, such as IMTs.…”

Section: Discussionmentioning

confidence: 99%

A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review

et al. 2019

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The inflammatory myofibroblastic tumor (IMT) is a rare tumor that can develop in any systemic organ. Its features are generally benign, but it often resembles malignancies and is treated surgically. Our patient was an 82-year-old female complaining of abdominal discomfort. Computed tomography demonstrated a 5 cm, ill-enhanced mass at the pancreas head. Upper gastrointestinal endoscopy revealed a duodenal submucosal tumor with apical erosion. Endoscopic ultrasonography (EUS) demonstrated a heterogeneous, low-echoic pancreas mass without clear margins. Fine-needle aspiration biopsy (FNAB) demonstrated spindle myofibroblastic tissues with lymphoplasmacyte and eosinophil infiltration, confirming an IMT diagnosis. Surprisingly, the tumor spontaneously regressed in one month without medication. Histological diagnosis using EUS-FNAB is essential for the rare pancreatic solid tumor like IMT.Medication had been initiated using nizatidine, rebamipide and oxetacaine, but it was not effective. She had a history of hypertension, but her family history was unremarkable. Blood tests showed modestly elevated IgG (1950 mg/dL, normal range: 870-1700 mg/dL) and C-reactive protein (0.43 mg/dL, normal range: ≤ 0.3 mg/dL) but normal readings for other factors, including serum tumor markers (carcinoembryonic antigen, carbohydrate antigen, and soluble IL-2 receptor), HbA1c, and IgG4 (66.1 mg/dL, normal: 4.5-117 mg/dL). Enhanced computed tomography (CT) demonstrated an ill-enhanced mass, 5 cm in size but with unclear margins, located at the pancreas head (Figure 1a,b). Upper gastrointestinal endoscopy revealed a submucosal tumor (SMT) with an apical erosion approximately 1.5 cm in size at the duodenal bulbs ( Figure 2). Several faintly enlarged lymph nodes were seen around the pancreas head, but no nodules suggestive of metastasis were visible in the liver or the lungs. Endoscopic ultrasonography (EUS) demonstrated a heterogeneous, low-echoic mass at the pancreas head and body, but no adhesion to the common bile duct. EUS elastography revealed a hardness of the pancreas lesion (Figure 3). Forceps biopsy (Radial Jaw™4, Boston Scientific Japan, 2.2 mm, Tokyo, Japan) from the duodenal SMT was not informative, but EUS-guided fine needle aspiration biopsy (FNAB) showed abundant spindle myofibroblast tissues with eosinophilic and lymphoplasmacytic cell infiltration (Figure 4). FNAB was performed with two punctures from the duodenal bulbs, with each puncture performed with 10 strokes using a 22-gauge Franseen-tip needle (Acquire™, Boston Scientific Japan) with 10 mL of negative pressure. No malignant cells were seen. The spindle cells were positive for anti-smooth muscle antibody (ASMA) and desmin but negative for discovered on GIST-1 (DOG-1), c-Kit, CD34, S-100, and ALK. Only six IgG4-positive cells were recognized in high-powered views, and no obliterative phlebitis or storiform fibrosis was detected. These findings led to the diagnosis of IMT.

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Comparison of the Diagnostic Yield of the Standard 22-Gauge Needle and the New 20-Gauge Forward-Bevel Core Biopsy Needle for Endoscopic Ultrasound-Guided Tissue Acquisition from Pancreatic Lesions

Cited by 19 publications

References 22 publications

Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions

Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions

Diagnostic yield of endoscopic ultrasound-guided tissue acquisition for small solid pancreatic lesions

A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review

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