Prospective comparison of slow-pull and standard suction techniques of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of solid pancreatic cancer

Abstract

BackgroundThe usage of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of solid pancreatic cancer is increasing, however mainly retrospective studies are available about the detailed methods of sampling.MethodsTo compare prospectively the diagnostic yield of EUS-FNA samples obtained with slow-pull (SP) and with standard suction technique (SS).ResultsEUS-FNA sampling was diagnostic in 72 of 92 cases (78.3%). Diagnostic yield was 67.4% in the SS and 65.2% in the SP group. The number of smear pairs (1.84 vs. 3.56; p < 0.001) and blood contamination (1.50 vs. 2.19; p < 0.001) were significantly higher in the SS group, which resulted in lower rate of diagnostic samples (41.8% vs. 30.0%; p = 0.003). There was no difference in the cellularity (1.58 vs. 1.37; p = 0.2554), or in the sensitivity and specificity in the identification of malignancy between SP and SS subgroups (69.9, 100% vs. 73.5, 100%). Histological samples were obtained in 60 cases (with SP: 49 cases; with SS: 46 cases). There was no difference in the diagnostic yield of histological samples between the groups (63 and 58.7%).ConclusionThe diagnostic yield, the cellularity of smears and the rate of acquiring sufficient histological material are similar in the SP and SS group, but due to lower bloodiness and decreased number of slides, the pathological diagnosis is faster and more cost-effective.

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology of Gastrointestinal Tract Tumors and Related Organs: Predictive Factors for Accurate Cytopathological Diagnosis

“…Our results agreed with previously performed studies who reported improved diagnostic accuracy of EUS when combined with FNAC and established the harmonizing role of EUS when added to EUS [5] [19] [20]. LV et al (2019) showed similar results to our study and confirmed the complementary role of EUS-FNAC in upgrading diagnostic accuracy of elastography [7].…”

“…The overall high values of sensitivity, specificity and diagnostic accuracy noticed in our work agreed with same ranges detected in study performed by Siddiqui et al On the other hand, Bor et al (2019) showed controversy results and illustrated that using standard suction technique showed significant association with cytological sufficiency. They also showed the significance of capillary suction (Slow pull suction) that should be performed for first passes and then followed by standard suction for subsequent passes in absence of ROSE [5]. Also, disagreement results showed by Inoue et al, 2016 that lesion size was the only factor showing significance association with cytological adequacy and correct diagnosis [27].…”

“…EUS-FNAC procedure with experienced hands can replace many other invasive and risky diagnostic procedures, such as mediastinoscopy, diagnostic laparoscopy and even laparotomy or thoracotomy. So, it is a less invasive technique than open biopsy and provides a cost-effective modality for the diagnosis and management of gastrointestinal lesions [5]. Moreover, unnecessary surgical interventions in advanced pancreatic cancer can be avoided with proper locoregional staging of pancreatic cancer being an integral part of the diagnosis and staging of pancreatic tumors with overall accuracy of EUS is superior to computed tomography (CT) scan and magnetic resonance imaging (MRI) for detecting pancreatic lesions [6].…”

“…Also needle movement back and forth by 10 to 20 times under EUS guidance was combined with suction to improve cellularity. Second one slow pull suction (capillary technique) in which material is obtained by the action of capillary pressure within the needle with no negative pressure applied at all [5]. Third method is Door Knocking technique that obtain cytological material by puncturing target lesion using maximal quick needle progression within it, for 15 -20 times, without advancement of needle outside lesion boundaries [10].…”

Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials

“…However, more recently, after publication of ESGE guidelines, several non-randomized and randomized trials have been performed comparing SU and SP [9][10][11] in sampling solid pancreatic lesions, trying to clarify this aspect.…”