Fine Needle Biopsies of Solid Pancreatic Lesions: Tissue Acquisition Technique and Needle Design Do Not Impact Specimen Adequacy

Abstract

Background and Aims Data on adequacy of EUS guided biopsies using different tissue acquisition techniques and fine needle aspiration needle designs have been inconclusive. Data on newer fine needle biopsy (FNB) needles are scarce. This study compared the performance of 3 acquisition techniques and 2 fine needle biopsy designs in solid pancreatic lesions. Methods Single-center, randomized, pilot clinical trial (Trial registration number NCT03264092). Patients undergoing EUS biopsy of pancreatic lesions were randomized to 1 of 3 acquisition techniques (dry suction, wet suction, slow pull) and 1 of 2 22G FNB needle designs. The primary outcome was specimen cellularity. Secondary outcomes included blood contamination and number of passes needed for diagnosis. Results A total of 52 (35.3%), 49 (33.3%) and 46 (31.3%) specimens were obtained with slow pull, dry suction and wet suction, respectively. A total of 56 (38%) and 91 (62%) specimens were obtained with each needle, respectively. No difference in cellularity scores was identified by technique (3.28 vs 3.55 vs 2.94; p = 0.081) or needle type (3.45 vs 3.15; p = 0.19). The same was true for blood contamination and diagnostic pass. A diagnosis was reached after 3 passes in 51 patients (93%). Histological diagnosis was possible in 45 specimens (82%). No severe adverse events occurred. Conclusions Cellularity of pancreatic specimens obtained with FNB needles via EUS was not influenced by technique and needle design. Three passes were enough to obtain a histological diagnosis in most patients. Larger clinical trials are required to validate the results of this study.

Wet-suction versus slow-pull technique for endoscopic ultrasound-guided fine-needle biopsy: a multicenter, randomized, crossover trial

“…As previously described for EUS-FNA 22 , slow-pull specimens resulted in lower blood contamination compared with wet-suction samples. This finding differs from the pilot study mentioned above, in which blood contamination was similar regardless of the sampling technique used 24 . However, the blood contamination score used was extremely simplified (score 0 = blood present and 1 = blood clots present), thus limiting the possibility of accurately differentiating and stratifying the results.…”

“…In contrast, for solid pancreatic lesions, tissue core procurement rate and tissue integrity score were similar between the two techniques. The present study seems to support the findings of a previous pilot study comparing wet suction with slow pull and standard suction for sampling of solid pancreatic lesions using end-cutting needles, where all three techniques resulted in similar histological yields 24 .…”

“…To date, a single-center pilot RCT has evaluated different sampling techniques on EUS-FNB of solid pancreatic lesions, comparing standard, slow-pull, and wet-suction methods, using both the fork-tip and Franseen-type needles. No difference in cellularity scores or blood contamination were found, regardless of the technique or needle type used 24 . However, the small sample size, inclusion of only solid pancreatic lesions, and the single-center design did not allow definitive conclusions to be drawn, leaving these issues still open for further evaluation.…”

Comparison of suction techniques for EUS-guided tissue acquisition: Systematic review and network meta-analysis of randomized controlled trials

“…Finally, 16 RCTs [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] with 2048 patients were included in the meta-analysis. Figure 1 shows the PRISMA diagram for study selection.…”

“…The number of needle passes was two in majority of the studies [11,12,15,17,[19][20][21]23]. Six studies [15,16,20,[23][24][25] had moderate risk of bias while 10 studies had low risk of bias [11][12][13][14][17][18][19]21,22,26] (Supplementary Figure 1). The definitions of various outcomes used in the included studies in shown in supplementary Table 1.…”