EUS Needle Identification Comparison and Evaluation study (with videos)

Abstract

Background and Aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) or biopsy is widely practiced. Optimal sonographic visualization of the needle is critical for image guided interventions. There are several commercially available needles but no bench-top testing and direct comparison of these needles to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. Methods Descriptive bench-top testing and comparison. Bench-top testing of 8 commonly used EUS-FNA needles (all of 22 gauge in size): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition, (Cook Medical); ClearView (Conmed); EZ Shot2 (Olympus); BNX (Beacon Endoscopic); and 2 new prototype needles that are coated by echogenic polymers by Medi-Globe. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in gastrointestinal ultrasound examination that is unfamiliar with EUS needle devices. Results There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, one prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (p<0.01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%–75% worse, p<0.001). Conclusions All FNA needles have their inherent and different echogenicity, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.

The cellularity yield of three different 22‐gauge endoscopic ultrasound fine needle aspiration needles

“…The overall complication rate in our study was 2.7%, which is comparable to the reported complication rates for EUS-FNA between 1 and 2.5%. 20 In our experience, there was no significant difference in sonographic echogenicity between the three needles. A recent study by Tang, et al compared eight of the most commonly used needles including our three needles.…”

“…Moreover, needles with clear echogenic features are ranked better than others amongst gastroenterologists. 20 The study did not look into the diagnostic accuracy or adequate sampling between needles. 20 In our experience, there was no significant difference in sonographic echogenicity between the three needles.…”

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

“…108 To facilitate localization using ultrasound, needles, particularly those used for endoscopy, may have surface modifications such as polymer coating or etching to enhance echogenicity. 109 Recently, ultrasound vibration of the needle has been used experimentally to enhance needle visibility. 110 Biopsy Device Form Factor, Maintenance, Reliability Form factor is the term used to specify the size, configuration, physical arrangement, and specifications of device hardware.…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…FNA needles have different echogenicity . In a multicenter study evaluating 10 different EUS needles, the polymeric‐coated needle showed the highest echogenicity …”

“…[49][50][51] In a multicenter study evaluating 10 different EUS needles, the polymeric-coated needle showed the highest echogenicity. 52 Consistent tissue core acquisition with EUS-guided biopsy has recently been achieved through the development of new side-and end-cutting EUS needles, with different mechanisms, calibers and design. 53 The Quick-Core needle (Cook Medical, Bloomington, IN, USA) is a 19-G-Tru-Cut biopsy needle; 54 the 19-and 22-G ProCore needles have a lateral opening with reverse-bevel technology.…”