Comparison between three types of needles for endoscopic ultrasound-guided tissue acquisition of pancreatic solid masses: a multicenter observational study

Abstract

It is debatable which needle has clear superiority of diagnostic performance in endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) of solid pancreatic masses. This study aimed to compare the performance of three needles and determine the variables that affect diagnostic accuracy. From March 2014 to May 2020, 746 patients with solid pancreatic masses who underwent EUS-FNB using three types of needles (Franseen needle, Menghini-tip needle, and Reverse-bevel needle) were retrospectively reviewed. Multivariate analysis using a logistic regression model was used to identify factors related to diagnostic accuracy. There were significant differences between the groups regarding the procurement rate of the histologic and optimal quality cores (Franseen vs. Menghini-tip vs. Reverse-bevel: 98.0% [192/196] vs. 85.8% [97/113] vs. 91.9% [331/360], P < 0.001 and 95.4% [187/196] vs. 65.5% [74/113] vs. 88.3% [318/360], P < 0.001, respectively). The sensitivity and accuracy using histologic samples were 95.03% and 95.92% for Franseen, 82.67% and 88.50% for Menghini-tip, and 82.61% and 85.56% for Reverse-bevel needles, respectively. In direct comparison between the needles using histologic samples, the Franseen needle showed significantly superior accuracy than the Menghini-tip (P = 0.018) and Reverse-bevel needles (P < 0.001). Multivariate analysis indicated that tumor size ≥ 2 cm (odds ratio [OR] 5.36, 95% confidence interval [CI] 3.40–8.47, P < 0.001) and fanning technique (OR 1.70, 95% CI 1.00–2.86, P = 0.047) were significantly associated with an accurate diagnosis. EUS-FNB using the Franseen needle enables the acquisition of a larger and more adequate histologic core tissue and achieves an accurate histological diagnosis when using the fanning technique.

Using Endoscopy in the Diagnosis of Pancreato-Biliary Cancers

“…Overall, the diagnostic yield does not differ between FNA and FNB needles, but it seems that FNB needles provide higher sample adequacy [ 28 , 29 , 30 , 31 ]. A recent meta-analysis suggested the non-superiority of 22G FNB needles over 22G FNA, with the only advantage being a similar diagnostic yield as FNA but with fewer passes [ 28 ].…”

The Latest Advancements in Diagnostic Role of Endosonography of Pancreatic Lesions

“…Table 3 presents superiority of EUS-FNB over EUS-FNA in the diagnosis of pancreatic cancer, however, they are equivalent when it comes to detecting SEL [34]. Although EUS-guided tissue acquisition is a standard modality for establishing a conclusive diagnosis and individualized therapeutic plan for pancreatic solid tumours, the diagnostic performance has been reported to have a wide range according to the needle type [44,45].…”

Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides

“… 28 , 29 , 30 , 31 Filter paper has been widely used as a receptacle for small biopsy specimens before fixation. 32 , 33 , 34 , 35 However, specimens mounted on filter paper are more likely to be absorbed into it, thereby decreasing the sample volume required for pathological diagnosis. Therefore, in the present study, we focused on the formalin fixation process after EUS‐TA to obtain increased sample volumes and investigated the effectiveness of oil blotting paper compared to that of filter paper for formalin fixation.…”

“…Hence, further efforts are required to improve the sampling adequacy for CGP tests 28–31 . Filter paper has been widely used as a receptacle for small biopsy specimens before fixation 32–35 . However, specimens mounted on filter paper are more likely to be absorbed into it, thereby decreasing the sample volume required for pathological diagnosis.…”