Endoscopic ultrasound-guided sampling of solid pancreatic masses: 22-gauge aspiration versus 25-gauge biopsy needles

Abstract

BackgroundBiopsy needles have recently been developed to obtain both cytological and histological specimens during endoscopic ultrasound (EUS). We conducted this study to compare 22-gauge (G) fine needle aspiration (FNA) needles, which have been the most frequently used, and new 25G fine needle biopsy (FNB) needles for EUS-guided sampling of solid pancreatic masses.MethodsWe conducted a retrospective cohort study of all EUS-guided sampling performed between June 2010 and October 2013. During the study period, 76 patients with pancreatic masses underwent EUS-guided sampling with a 22G FNA needle (n = 38) or a 25G FNB needle (n = 38) for diagnosis. An on-site cytopathologist was not present during the procedure. Technical success, the number of needle passes, cytological diagnostic accuracy, cytological sample quality (conventional smear and liquid-based preparation), histological diagnostic accuracy, and complications were reviewed and compared.ResultsThere were no significant differences in technical success (100 % for both), the mean number of needle passes (5.05 vs. 5.55, P = 0.132), or complications (0 % for both) between the 22G FNA group and the 25G FNB group. The 22G FNA and 25G FNB groups exhibited comparable outcomes with respect to cytological diagnostic accuracy (97.4 % vs. 89.5 %, P = 0.358) and histological diagnostic accuracy (34.2 % vs. 52.6 %, P = 0.105). In the cytological sample quality analysis, the 25G FNB group exhibited higher scores for the amount of diagnostic cellular material present (22G FNA: 0.92 vs. 25G FNB: 1.32, P = 0.030) and the retention of appropriate architecture (22G FNA: 0.97 vs. 25G FNB: 1.42, P = 0.010) in the liquid-based preparation. The 25G FNB group showed a better histological diagnostic yield for specific tumor discrimination compared with the 22G FNA group (60 % vs. 32.4 %, P = 0.018).ConclusionsUse of the 25G FNB needle was technically feasible, safe, efficient, and comparable to use of the standard 22G FNA needle in patients with solid pancreatic masses in the absence of an on-site cytopathologist. The cytological sample quality in the liquid-based preparation and the histological diagnostic yield for specific tumor discrimination of EUS-guided sampling using a 25G FNB needle were significantly higher than those using a 22G FNA needle.

Performance of the Standard 22G Needle for Endoscopic Ultrasound-guided Tissue Core Biopsy in Pancreatic Cancer

“…The procurement of visible core was obtained in all cases in our [4,6,10,22]. Conversely, there is one paper showing a diagnostic rate of 34% based on core biopsy with a 22G needle and five passes [23].…”

Fine‐needle aspiration and core needle biopsy: An update on 2 common minimally invasive tissue sampling modalities

“…EUS-FNA has a proven track record as a relatively safe procedure for sampling solid pancreatic lesions, with sensitivities and diagnostic accuracies in the range of 80% to 95%. [42][43][44] In a study evaluating pancreatic mass sampling via EUS-FNA with a 25-gauge needle compared with percutaneous ultrasound-guided CNB using an 18-gauge needle, Sur et al described no significant differences with regard to the accuracy, technical failure rate, sensitivity, or specificity between modalities; however, CNB had a significantly higher diagnostic yield (86%) compared with EUS-FNA (66%). 45 More recent advances in needle technology have enabled the endoscopist to obtain true tissue fragments comparable to CNB specimens from the minimally invasive endoscopic approach, such as the cutting reverse bevel EchoTip ProCore needle (Cook Medical, Bloomington, Ind) or the cutting SharkCore needle (Beacon Endoscopic, Newton, Mass).…”

“…Although one study demonstrated the superiority of EUS-FNA using a 22-gauge needle compared with 22-gauge EUS-EchoTip ProCore biopsies of solid pancreatic lesions, 43 other publications have described superior diagnostic yield, more cellular cell blocks for ancillary testing, and more specific tumor characterization for EUS-EchoTip ProCore biopsies compared with EUS-FNA specimens. 42,44,46 Lung lesions Peripheral lung nodules are frequently sampled by computed tomography-guided percutaneous transthoracic sampling, either by FNA or CNB. As reflected in the recently published 4th edition of the World Health Organization classification for lung, pleura, thymus, and heart tumors, 47 the amount and type of information needed from these small biopsy specimens have evolved.…”

“…For over 2 decades, EUS‐FNA has been the preferred minimally invasive sampling modality for patients with solid pancreatic lesions. EUS‐FNA has a proven track record as a relatively safe procedure for sampling solid pancreatic lesions, with sensitivities and diagnostic accuracies in the range of 80% to 95% . In a study evaluating pancreatic mass sampling via EUS‐FNA with a 25‐gauge needle compared with percutaneous ultrasound‐guided CNB using an 18‐gauge needle, Sur et al described no significant differences with regard to the accuracy, technical failure rate, sensitivity, or specificity between modalities; however, CNB had a significantly higher diagnostic yield (86%) compared with EUS‐FNA (66%) .…”

“…More recent advances in needle technology have enabled the endoscopist to obtain true tissue fragments comparable to CNB specimens from the minimally invasive endoscopic approach, such as the cutting reverse bevel EchoTip ProCore needle (Cook Medical, Bloomington, Ind) or the cutting SharkCore needle (Beacon Endoscopic, Newton, Mass). Although one study demonstrated the superiority of EUS‐FNA using a 22‐gauge needle compared with 22‐gauge EUS‐EchoTip ProCore biopsies of solid pancreatic lesions, other publications have described superior diagnostic yield, more cellular cell blocks for ancillary testing, and more specific tumor characterization for EUS‐EchoTip ProCore biopsies compared with EUS‐FNA specimens …”