Suction versus slow-pull for endoscopic ultrasound-guided fine-needle aspiration of pancreatic tumors: a prospective randomized trial

Abstract

Background: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses.Methods: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique.Results: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. Conclusions: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.

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

“…▶ Table 1 summarizes the characteristics of the seven included studies [10,11,[17][18][19][20][21]. They were all full-text RCTs published between 2017 and 2019; two were initially available only as abstracts from conferences' proceedings at the time of submission that during the revision process became available as full text and whose data were accordingly updated [20,21]. Only two studies [10,20] were multicentric.…”

“…Only two studies [10,20] were multicentric. Two studies were carried out in the US [10,11], 2 in Korea [18,19] and one each in Brazil [21], India [17] and Italy [20]. Different needles were employed, with 3 studies employing FNB needles [11,19,20] and 4 FNA [10,17,18,21]).…”

“…Two studies were carried out in the US [10,11], 2 in Korea [18,19] and one each in Brazil [21], India [17] and Italy [20]. Different needles were employed, with 3 studies employing FNB needles [11,19,20] and 4 FNA [10,17,18,21]). Four of the studies randomized distinct individual patients with solid pancreatic lesions to either SU or SP sampling [10,11,17,20], for a total of 327 patients (164 SP, 163 SU); the remaining 3 studies [18,19,21] randomized the same patients with solid pancreatic lesions to both SU and SP sampling in a random order, for a total of 148 patients.…”

“…Five of the seven examined studies [17,21] reported data on the degree of blood contamination. We calculated the rate of highest degree of blood contamination as defined in the 5 studies as "blood clots present" [17], "blood in > 50 % of the slide" [19], "interference with the making of pathological diagnosis due to large amount of blood cells" [18], significant blood contamination [20] and red blood cells > 50 % [21]. The pooled rate of high blood contamination resulted higher with SU, being of 19.7 % (95 % CI 6.8 %-45.4 %; I 2 = 92.6 %) with SP and 27.6 % (95 % CI 13.2 %-48.8 %; I 2 = 90 %) with SU (Supplementary Fig.…”

“…In the studies with fair-good quality scores the pooled rate of high blood contamination was 21 % with SP and 30.6 % with SU. The difference remained in the two studies conducted on distinct individual patients with solid pancreatic lesions [17,20], with a pooled rate of high blood contamination of 13.6 % for SP and 22 % for SU, while it resulted less evident being 24.7 % for SP and of 26.4 % (95 % CI 5.9 %-24.7 %, I 2 = 42.8) for SU in the 3 studies sampling the same lesions in a random order [18,19,21]. Notably, while in the 2 studies employing FNB [19,20] the pooled rate of high blood contamination was 13.7 % with SP and 15.7 % with SU, in the 3 studies using FNA [17,18,21] this was 25.2 % with SP and 37.4 % with SU.…”