High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial

Kudo, Taiki; Kawakami, Hiroshi; Hayashi, Tsuyoshi; Yasuda, Ichiro; Mukai, Tsuyoshi; Inoue, H.; Katanuma, Akio; Kawakubo, Kazumichi; Ishiwatari, Hirotoshi; Doi, Shinpei; Yamada, Reiko; Maguchi, Hiroyuki; Isayama, Hiroyuki; Mitsuhashi, Tomoko; Sakamoto, Naoya

doi:10.1016/j.gie.2014.04.012

Cited by 84 publications

(72 citation statements)

References 28 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…al reported contamination in 13% of samples utilizing standard suction technique. 23,24 In comparison, we found a significant reduction in GI tract contamination once RNP was neutralized (6.7% versus 16.7% in control samples). We utilized rapid on-site cytopathology evaluation, which likely explains our excellent rates of diagnostic cytology yield, similar to multiple studies that have demonstrated higher yield with the use of on-site cytopathology.…”

Section: Discussionmentioning

confidence: 63%

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

Aadam

Shidham

et al. 2015

Dig Dis Sci

View full text Add to dashboard Cite

BACKGROUND Prior to withdrawing the EUS-FNA needle from the lesion, the stopcock of the suction-syringe is closed to reduce contamination. Residual negative pressure (RNP) may persist in the needle despite closing the stopcock. AIMS To determine if neutralizing RNP before withdrawing the needle will improve the cytology yield. METHODS Bench-top testing was done to confirm the presence of RNP followed by a prospective, randomized, cross-over study on patients with pancreas mass. Ten-mL suction was applied to the FNA needle. Before withdrawing the needle from the lesion, the stopcock was closed. Based on randomization, the first pass was done with the stopcock either attached to the needle (S+) or disconnected (S−) to allow air to enter and neutralize RNP and accordingly the second pass was crossed over to S+ or S−. On-site cytopahtologist was blinded to S+/S−. RESULTS Bench tests confirmed the presence of RNP which was successfully neutralized by disconnecting the syringe (S−) from the needle. Sixty patients were enrolled, 120 samples analyzed. S+ samples showed significantly greater GI-tract contamination compared to S− samples (16.7% vs. 6.7%, p=0.03). Of the 53 patients confirmed to have pancreas adenocarcinoma, FNA using S− approach was positive in 49 (93%) compared to 40 using the S+ approach (76%, p=0.02). CONCLUSIONS Despite closing the stopcock of the suction-syringe, RNP is present in the FNA needle. Neutralizing RNP prior to withdrawing the needle from the target lesion significantly decreased GI-tract contamination of the sample thereby improving the FNA cytology yield.

show abstract

Section: Discussionmentioning

confidence: 63%

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

Aadam

Shidham

et al. 2015

Dig Dis Sci

View full text Add to dashboard Cite

show abstract

“…Our RCTs demonstrated the feasibility of tissue acquisition with 22-or 25-gauge needles using a previously reported scoring system [7,9]. In many patients, an adequate specimen is necessary in order to confirm the tumor histological subtype using immunohistochemical analysis, necessary for selecting a neoadjuvant chemotherapy regimen, especially for tumors that are borderline resectable.…”

mentioning

confidence: 66%

“…Although dedicated instruments make this procedure much easier, samples are easily obtained using only syringes and extension tubes. Although it has been speculated that negative pressure is useful because it holds the tissue against the cutting edge of the needle instead of aspirating tissue into the needle [6], my group reported the utility of high negative pressure (50 mL) compared to customary negative pressure (10 mL) when using 25-gauge needles [7]. We reported significantly higher specimen acquisition rates for adequate histological diagnosis in the high negative pressure group compared to those in the normal negative pressure group (90.0 vs. 72.2 %, P = 0.0003).…”

mentioning

confidence: 99%

Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Gastrointestinal and Pancreatic Tumors: Is Negative Pressure Helpful or Does It Suck?

2015

Self Cite

View full text Add to dashboard Cite

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) facilitates endoscopic tissue acquisition. The technique is affected by two major categories of factors: that influencing sample acquisition and that influencing sample interpretation, some subject to controversy [1]. The former factors include: the degree of technical difficulty (location of the lesion), the type of lesion (solid or cystic), the diameter of the needle (19-, 22-, or 25-gauge), the number of punctures, the use of negative pressure (presence and amount including capillary aspiration, namely slow-pull technique), the presence of stylets, the presence of rapid on-site evaluation (ROSE), the type of needle (a dedicated biopsy needle, with or without a side hole at the needle tip, and with or without a core trap at the needle tip), any special maneuvers (''fanning'' technique) used, and the experience and skills of the endosonographer. The factors affecting interpretation are contamination and mimicry of other types of lesions.There is current controversy concerning the use of negative pressure suction, with regard to the decision of whether or not to use suction and the selection of an appropriate target and force of suction. In EUS-FNA, negative pressure is applied using suction with a 10-or 20-mL syringe, which increases the quantity of the extracted sample at the expense of occasionally increasing the probability of blood contamination. In general, the outcome of a specimen gathered during EUS-FNA is determined based on the diagnostic ability of cytologist or pathologist, acquisition of an appropriate and sufficient specimen (cellularity), contamination from the gastrointestinal (GI) tract, and observed blood contamination on slides. In the two randomized controlled trials (RCTs) that have so far evaluated the contribution of negative pressure during EUS-FNA for lymph nodes [2] or solid lesions [3], the use of negative pressure did not improve diagnostic accuracy, but did increase blood contamination. In one RCT, although the use of negative pressure increased the cellularity of the specimens obtained (P = 0.01), the diagnostic accuracy did not significantly differ from that of EUS-FNA without negative pressure (P = 0.73) [2]. Therefore, based on the available data, EUS-FNA without negative pressure is recommended by most experts [1]. If the obtained specimen is minimal, such as in cases of chronic pancreatitis, negative pressure can be used to enable the acquisition of a larger specimen [1]. Nonetheless, while most reports focus on cytology, histological tissue quality has rarely been investigated.In this issue of Digestive Diseases and Sciences, Aadam et al. [4] hypothesized that negative pressure still persists in the aspirating needle despite closing the suction-syringe stopcock. They first examined the effect of stopcock closure and the removal of the syringe itself using an in vitro model system that confirmed the presence of residual negative pressure inside and up to the tip of the needle after closing the stopcock that was succ...

show abstract

“…[596061] Suction may contaminate the sample with blood, clouding cytologic interpretation. EUS-FNA done without suction or by slow-pull technique seems to fare better in terms accuracy and sensitivity of cytologic diagnoses, resulting in only slight blood contamination when aspirating solid lesions.…”

Section: Techniques To Increase Diagnostic Yieldmentioning

confidence: 99%

“…without) suction is superior for tissue acquisition;[59] higher suction pressure seems to yield more tissue. [6163] Biopsy by wet suction technique will also enhance tissue procurement. [64]…”

Section: Techniques To Increase Diagnostic Yieldmentioning

confidence: 99%

Clinical use of endoscopic ultrasound-guided fine-needle aspiration: Guidelines and recommendations from Chinese Society of Digestive Endoscopy

et al. 2017

View full text Add to dashboard Cite

High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial

Abstract: Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has a

Cited by 84 publications

References 28 publications

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Gastrointestinal and Pancreatic Tumors: Is Negative Pressure Helpful or Does It Suck?

Clinical use of endoscopic ultrasound-guided fine-needle aspiration: Guidelines and recommendations from Chinese Society of Digestive Endoscopy

Contact Info

Product

Resources

About