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

Abstract

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.

Role of Endoscopic Ultrasonography-Guided Fine Needle Aspiration/Biopsy in the Diagnosis of Autoimmune Pancreatitis

“…As for procedure-related adverse events, EUS-FNB was associated with a higher adverse event rate than EUS-FNA in our study, though this was not statistically significantly (20.0% vs. 0%, p = 0.143). Previous studies comparing EUS-FNA and EUS-FNB for solid pancreatic mass reported no significant difference in adverse event rates [ 16 , 19 , 44 ]. Since the adverse event rate of EUS-FNB in our cohort appeared too high, further investigation with a larger cohort is warranted.…”

“…Fifty percent of patients were diagnosed with pathologically definite LPSP in patients who underwent EUS-FNB, though none were diagnosed of those who underwent EUS-FNA (50.0% vs. 0%, p = 0.002). FNB needles can acquire a larger amount of tissue with better preservation of tissue architecture than FNA needles [ 17 , 19 , 41 , 42 ]. Thus, special staining, such as Elastica van Gieson staining and IgG4 immunostaining, can be performed and is speculated to improve diagnostic yield of EUS-FNB.…”

“…Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is an established technique of sample acquisition from the pancreas for cytological evaluation [ 11 , 12 , 13 , 14 ]. Novel needles have been developed with side holes or dedicated tip designs to obtain adequate tissue samples for histological evaluation and are called EUS-guided fine needle biopsy (EUS-FNB) needles [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Recently, the diagnostic yield of EUS-FNA for AIP has been reported [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], and EUS-FNB is expected to provide the better yield [ 25 , 36 ].…”

Pancreatic cancer with ovarian metastases: A case report and review of the literature

“…In our case, the ultrasound-guided biopsy exerted an important role in pre-operative diagnosis. Nowadays, the value of endoscopic ultrasonography for the differential diagnosis of various pancreatic lesions (malignant, low-grade malignant, and benign) has been widely depicted[ 18 - 21 ].…”

Tissue acquisition and pancreatic masses: Which needle and which acquisition technique should be used?

“…On the basis of the available literature, FNB has shown a diagnostic yield of more than 90 % [14]. Moreover, the diagnostic performance of FNB sampling of pancreatic masses was significantly better than FNA sampling, and was also associated with ease of diagnosis and shorter viewing times by the pathologists [15].…”