Fine-needle aspiration biopsy of abdominal lesions: diagnostic yield for different needle tip configurations.

Abstract

Four fine-needle aspiration biopsy needles with different tip configurations were used in 133 patients with abdominal lesions. The 20-gauge needles were used in random sequence by several physicians. The specimen from each of the 522 needle passes was evaluated by two cytopathologists for adequacy to render a diagnosis and for the presence of cell block material. The Franseen needle produced a 16% and 9% better yield for diagnostic material than did the cut biopsy and spinal needles (P less than .05), respectively. The Westcott needle was better than the cut biopsy needle by 13%, and the spinal needle produced an 11% better yield than did the cut biopsy needle. Differences did not exist in liver biopsies but were present in pancreatic biopsies. The spinal needle was the least successful in yielding cell block material. Use of the cut biopsy needle resulted in the largest proportion of inadequate specimens, except its yield in cell blocks in the liver was 25% higher than that of the Westcott needle. The authors conclude that not all unusual designs for 20-gauge needle tips render results superior to those of the simple spinal needle.

Cytologic analysis in fine-needle aspiration biopsy: smears vs cell blocks.

“…Even if cytologic smears are reviewed immediately, it is helpful to know that diagnoses can be made in almost 90% of patients after two passes of a needle. Indeed, our results are similar to those of Dahnert et al [9], who obtained material adequate to establish a definitive diagnosis with the first two passes in 82% of abdominal biopsies, with marginal increases of 8% with the third pass, 6% with the fourth pass, 2% with the fifth pass, and 1% with the sixth pass. This information may also lead to termination of a procedure after two passes despite an immediate cytologic report that is nondiagnostic, if the procedure is believed to pose a higher than normal risk to the patient or if the patient is having difficulty cooperating.…”

Fine needle aspiration of abdominal organs: a review of current recommendations for achieving a diagnostic sample

“…Interestingly, the needle with the largest internal diameter (cut biopsy needle) yielded the largest proportion of specimens that were considered insufficient for evaluation. These results support the previous study findings that larger gauge needles do not necessarily increase the likelihood of obtaining a diagnostic sample (Dähnert et al 1992 ).…”

“…A human study by Dähnert et al ( 1992 ) compared four different types of needles, all of similar gauge but with a slightly different internal diameter. The 20 G trephine, 20 G slotted, 19.5 G cut biopsy and 20 G spinal needle were compared, using a total of 551 needles for abdominal organ tissue aspiration.…”

“…A definitive diagnosis was obtained in 61% of human abdominal FNA cases with the first needle pass, with a further increase of 21% with the second FNA attempt using a new needle, 8% with the third FNA attempt and 6% with the fourth FNA attempt (Dähnert et al 1992 ). Therefore, slides from at least four or five aspirates should be submitted from each lesion sampled.…”

Influence of operator experience on performance of ultrasound-guided percutaneous liver biopsy

“…In our study, we did not find any difference for the final histological diagnosis between the experienced group versus the inexperienced group composed of operators having performed less than 15 procedures alone. This point could be explained as follows: the learning curve with semi-automated needles could be quicker than the one with the aspiration-type or tru-cut-type manual needles used in the previously published series [3,7] and for which physician experience is very important [28]. Also, both series were multicentric, and one of them was retrospective, making uniform and invariably extensive teaching difficult.…”