The diagnostic performance of novel torque technique for endoscopic ultrasound‐guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial

Abstract

Background and Aim Although several techniques for improved outcomes in endoscopic ultrasound (EUS)‐guided tissue acquisition have been reported, the reported diagnostic yield for pancreatic masses is not satisfactory. The effects of novel technique (torque method) on twisting the scope in the clockwise or counterclockwise direction during EUS‐fine needle biopsy (EUS‐FNB) are unknown. We compared the diagnostic yield of EUS‐FNB for pancreatic masses using the torque and standard techniques. Methods From April 20, 2017, to March 16, 2018, 124 consecutive patients with solid pancreatic mass who underwent EUS‐FNB using either the torque or standard technique were randomly assigned. Three passes were made with each technique, comprising 10 uniform to‐and‐fro movements on each pass with a 10‐mL syringe suction. The primary outcome was procurement rates of histologic cores, and the secondary outcomes were the diagnostic performance and technical failure. Results There were significant differences between the groups regarding the procurement rate of the histologic core and optimal quality core (standard vs torque: 87.1% [54/62] vs 98.4% [61/62], P = 0.038 and 79.0% [49/62] vs 93.5% [58/62], P = 0.037). The sensitivity, specificity, positive predictive value, and negative predictive values of EUS‐FNB were 85.45%, 100%, 100%, and 46.67%, respectively, for the standard technique and 96.49%, 100%, 100%, and 71.43%, respectively, for the torque technique. The diagnostic accuracies of the standard and torque techniques were 87.10% and 96.77%, respectively. Conclusions The torque technique for EUS‐FNB offered acceptable technical feasibility and superior diagnostic performance, including optimal histologic core procurement, compared with the standard technique.

Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE)

“…Seeking another maneuver with equal or superior diagnostic outcomes as the fanning technique without its limitations, Park et al 48 invented an alternative and similar technique called the “torque technique.” Torque is applied by twisting the body of the echoendoscope to the right (clockwise) or left (counter-clockwise) without using the left/right control knob. In that study, the authors demonstrated that the torque technique was significantly superior to the standard technique with respect to sensitivity and diagnostic accuracy.…”

Tissue acquisition and pancreatic masses: Which needle and which acquisition technique should be used?

“…Diagnostic accuracy of the ST and TT was 87.1 % and 96.8 %, respectively. In conclusion, the TT for EUS-TA offered acceptable technical feasibility and superior diagnostic performance, including optimal histologic core procurement, compared with the ST [41]. No study comparing the FT vs TT has yet been published.…”

Macroscopic on-site evaluation (MOSE) of specimens from solid lesions acquired during EUS-FNB: multicenter study and comparison between needle gauges

“…The standard technique (ST) consists in placing the tip of the needle within the lesion, moving the needle to-and-fro on the same axis, regardless of the TA technique applied (standard suction, slow-pull, wet or non-suction technique). Two other techniques, such as the fanning technique (FT) and the torque technique (TT) have also been proposed to establish an accurate diagnosis with fewer needle passes 20 21 showing different results. No study comparing the FT vs TT has been published yet.…”