Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Abstract

Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an accurate technique for sampling intraintestinal and extraintestinal lesions. However, cytology possesses certain limitations, which may be overcome if histological specimens are provided to the pathologist.Aim: The aim of the study was to evaluate the accuracy of a newly developed 19G histology needle.Methods: Retrospective analysis of a prospectively collected data base including patients who underwent EUS-guided biopsy with the 19G ProCore TM histology needle for the evaluation of intraintestinal or extraintestinal lesions. Samples were obtained after one needle pass, recovered into ThinPrep ® and processed for histological analysis. Results were compared to the gold standard of surgical histopathology, or global pathological, clinical and radiological assessment, and follow-up in non-operated cases. Results are shown as mean ± SD. Percentage of optimal samples for histological evaluation and the overall diagnostic accuracy were evaluated.Results: 87 patients (mean age 62.9 years, range 25-88 years, 36 woman) were included. Lesions mean size was 41.6 ± 21.3 mm. 66 lesions (75.9 %) were considered as malignant and 21 (24.1 %) as benign. EUS-guided biopsy was feasible in all cases (100 %). Sample quality was adequate for histological assessment in 82 lesions (94.2 %). In the remaining cases the sample was adequate for cell-block evaluation. Sensitivity, specificity, PPV, NPV, and overall accuracy for malignancy were 93.4 %, 100 %, 100 %, 84 %, and 95.4 %, respectively. There were no complications related to the procedure. Conclusion:The EUS-guided biopsy with the 19G histology needle provides with an optimal core sample for histological evaluation allowing a high histopathologic diagnostic accuracy.

Should EUS-guided tissue acquisition for histologic examination replace fine needle aspiration for cytologic examination?: another brick in the wall

“…Their recommendations, however, are not evidence based and there are no studies directly comparing commercially available needles. Indeed, as shown in the present study and in the previous multicenter published experience (24,28), use of the 19G Procore TM is associated with very high technical success and performance rates even, when used transduodenally by expert endosonographers. Despite these results the use of a particular needle will likely be based upon personal preference of the echoendoscopist until more definitive data will become available.…”

“…Another important aspect is the best way to process the specimens obtained with EUS-FNB (30). As pointed out by Iglesias-Garcia et al (28), in the first feasibility study using the 19G Procore TM (24) each of the participating centers did not apply a uniform protocol to retrieve the sample from the needle (some by reinserting the stylet, others by flushing with saline) and to prepare the sample before processing in the pathology lab [samples were placed in formalin or in a liquid-based preparation, ThinPrep ® (hologic Corp, Bedford, MA)]. Interestingly, the interobserver agreement among five expert pathologists in grading the quality of specimens obtained in the five participating centers was found to be excellent and particularly high (91.2 %) with regard to sample adequacy, with a Fleiss' κ of 0.73 (95 % CI 0.61-0.81) (31).…”

“…Whether all of these efforts will change the practice of EUS from cytological based to histological based remains to be determined. however, the article by Iglesias-García et al (28) represents another brick in the wall of evidence that needs to be built before EUS-FNB can become the standard of practice.…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…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 . The Quick‐Core needle (Cook Medical, Bloomington, IN, USA) is a 19‐G‐Tru‐Cut biopsy needle; the 19‐ and 22‐G ProCore needles have a lateral opening with reverse‐bevel technology . A meta‐analysis of nine studies showed no significant differences between the 22‐G ProCore and the standard 22‐G FNA needles in diagnostic adequacy, accuracy, or histological core specimen acquisition .…”

“…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. 55,56 A metaanalysis of nine studies showed no significant differences between the 22-G ProCore and the standard 22-G FNA needles in diagnostic adequacy, accuracy, or histological core specimen acquisition. 57 Recently, other types of needle, specifically conceived for EUS-FNB, have become available.…”