Effectiveness of introducing a 20-gauge core biopsy needle with a core trap in EUS-FNA/B for diagnosing pancreatic cancer

Abstract

Background Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is a standard method for pathological diagnosis of pancreatic solid lesions. The EchoTip ProCore 20G® (PC20), a 20-gauge biopsy needle with a forward-bevel core trap, has been available in Japan since 2015. Methods We compared the efficacy of the PC20 with that of the EchoTip ProCore 22G® (PC22) and Acquire 22G® (AC22) in EUS-FNA/B for diagnosing pancreatic cancer. This retrospective study included 191 patients with pancreatic cancer who underwent EUS-FNA/B using the PC20, PC22, or AC22 at our facility from April 2013 to October 2019. We investigated the patients’ clinical characteristics and the diagnostic accuracy and safety of each needle. Results A sufficient stroke length of puncture was secured in all patients. The maximum length under EUS was shorter with the AC22 (22.1 ± 2.2 mm) than PC20 (30.6 ± 0.7 mm, p < 0.01) and PC22 (30.3 ± 0.8 mm, p < 0.01). The histological accuracy was 96.4% with the PC20 but only 58.8% with the PC22 (adjusted p (p-adj) < 0.0001) and 75.0% with the AC22 (p-adj = 0.06). The diagnostic accuracy of the combination of histology and cytology was 96.4% with the PC20, while it was 72.1% with the PC22 (p-adj < 0.0001) and 91.7% with the AC22 (p-adj > 0.99). One patient (0.9%) in the PC20 group developed mild pancreatitis, but no adverse events occurred with the other needles. Conclusions The PC20 showed better diagnostic capability than the PC22. The diagnostic efficacy was similar between the PC20 and AC22. The high histological accuracy of the PC20 could be advantageous for lesions in which histological assessment is critical.

Endoscopic Ultrasound-Guided Tissue Acquisition Versus Fine Needle Aspiration for Diagnosis of Pancreatic Ductal Adenocarcinoma

“…An MC was defined as a fragment of intact tissue at least 0.055 mm long on its major axis. This is in agreement with the literature, which reports some similar definitions of MC, e.g., a fragment as large as a high-power microscopic field [ 18 ]. This scoring system is simple to use in routine procedures and can easily distinguish between inadequate and adequate tissue samples for cytology.…”

“…A recent multicenter case series on PC20 in pancreatic (62.2%) and extra-pancreatic tumors reported adequacy, accuracy, sensitivity, and specificity of 92.4%, 91.5%, 90.8%, and 100%, respectively, for pancreatic lesions [ 17 ]. Another study compared the effectiveness of PC20 with the former ProCore® 22G (PC22) and Acquire® (Boston Scientific, Marlborough, MA, USA) 22G (AC22) for diagnosing PDA in 191 patients [ 18 ]. Sensitivity was 96.4% with PC20, 58.8% with PC22, and 75% with AC22, with one case of acute pancreatitis occurring after the use of the PC20 needle.…”

“…The authors concluded that PC20 had greater diagnostic capacity than PC22. Both PC20 and AC22 had similar accuracy, but the sensitivity of PC20 was higher for lesions in which histological evaluation is essential due to the superior quality of the MC obtained [ 18 ]. This occurred in our study, where the sensitivity, specificity, PPV, NPV, and accuracy for diagnosing a PDA with PC20 were 95%, 100%, 100%, 85%, and 96.1%, respectively, which is higher than previously reported elsewhere.…”

“…The old PC22 needle showed a sensitivity of 80% for pancreatic lesions <2 cm. For those with a mean diameter of 32 mm, the sensitivity was 87.5% with a single puncture [ 18 ], and 97.8% with two punctures [ 19 ]. In our study, the PC20 needle reached a sensitivity of 95% versus 93.5% for the 22G needle (p=0.642).…”

Comparison of 19-gauge aspiration needles with 20-gauge forward-bevel needles for the diagnosis of autoimmune pancreatitis: a prospective randomized, controlled study

“…Compared with the earlier 22G reverse-beveled needle (ProCore™), the 20G needle offers better maneuverability and greater tissue acquisition [22]. Indeed, the histological accuracy of the 20G FNB needle has been reported to be as high as 96.4% in pancreatic carcinoma patients [23]. For AIP, ~ 45% of patients with highly-suggestive features of AIP were diagnosed with level 1 or 2 histological ndings via the 20G forward-bevel FNB needle [13].…”