Diagnostic accuracies of endoscopic ultrasound-guided fine-needle aspiration with distinct negative pressure suction techniques in solid lesions: A retrospective study

Abstract

Abstract. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) is highly accurate in obtaining specific diagnoses for various diseases. The present study aimed to evaluate the diagnostic yields, accuracies and sampling adequacies, of slow-pull, 5 ml suction and 10 ml suction techniques in EUS-FNA of solid lesions. The present study was a retrospective comparative study, which was performed in tertiary academic centers, recognized for their expertise in EUS and EUS-guided FNA. The present study involved 149 patients who underwent EUS-FNA of solid masses. A total of 34 (22.8%), 37 (24.8%) and 78 (52.4%) patients underwent EUS-FNA with slow-pull, 5 ml suction and 10 ml suction techniques, respectively. The EUS-FNA cytology and histology results were compared with those from the gold standard of surgical histopathology [hematoxylin-eosin staining; immunohistochemical test of cluster of differentiation (CD) 79a, CD20 and flow cytometry test] or long-term clinical follow-up. The present retrospective comparative study demonstrated that the diagnostic yields and accuracies of EUS-FNA with slow-pull (86.1%) were significantly superior to those achieved with 5 ml suction (83.3%) or 10 ml suction (69.9%; P<0.0001; χ 2 test). Consistently, 86.5% (32/37) of the samples obtained from the 5 ml suction group were adequate for histological diagnosis. By contrast, 70.6 (24/34) and 85.9% (67/78) of samples from the slow-pull and 10 ml suction groups were adequate for histological diagnosis, respectively. The samples obtained using 10 ml suction contained more blood compared with those obtained via slow-pull and 5 ml suction (P=0.0056; χ 2 test). No complications were noted in any of the three groups. The samples that were obtained for histopathological diagnosis using 5 ml suction were superior to those obtained using slow-pull or 10 ml suction. Additional multi-central prospective studies in which EUS-FNA is performed with variable negative pressures are required to improve the defining of the diagnostic roles of those techniques. IntroductionEndoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) has been reported to be a sensitive method for tissue sampling of suspicious lesions of the gastrointestinal lumen and adjacent structures, including pancreaticobiliary and esophageal lesions, gastric malignancies and mediastinal and intra-abdominal lymphadenopathies (1-6). The diagnostic accuracy of EUS-FNA ranges between 60 and 90%, according to the site being evaluated (1,7-11). Cytological study of the material obtained by FNA allows for the evaluation of cellular findings that are indicative of malignancy. However, EUS-FNA has a number of limitations. Certain neoplasms, including lymphomas, stromal tumors and well-differentiated neoplasias are difficult to diagnose without histological samples, since tissue architecture and cell morphology are essential for accurate pathological assessments, which include immunohistochemical analyses in such cases (12)(13)(14). In addition, the accuracy of EUS-FNA depend...

A Meta-analysis of Slow Pull versus Suction for Endoscopic Ultrasound-Guided Tissue Acquisition

“…The initial search identified a total of 898 publications and after screening for eligibility, 17 studies with 1,616 cases were included in the analysis; seven RCTs, [21][22][23][24][25][26][27] four pro-spective studies, [28][29][30][31] and six retrospective studies 8,[32][33][34][35][36] (Fig. 1).…”

Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle: a prospective study

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Endoscopic ultrasonography in pancreatic diseases: advances in tissue acquisition

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