Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling

Abstract

OBJECTIVE. Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (EUS-FNA) may facilitate tissue sampling for histopathological diagnosis of subepithelial tumors (SETs) in the gastrointestinal (GI) tract. However, immunohistochemistry is not always feasible using EUS-FNA samples due to the low quality of specimens often obtained by aspiration. This study aimed to compare the use of 22-gauge (G) EUS-guided fine-needle biopsy (EUS-FNB) with 22G EUS-FNA for core sampling used for histopathological examination, including immunohistochemistry, in patients with GI SETs. METHODS. Twenty-eight patients with GI SETs ≥2 cm in size were prospectively enrolled at five university hospitals in Korea between January and June 2013. They were randomized to undergo either EUS-FNB or EUS-FNA. RESULTS. A total of 22 patients was finally analyzed in this study: 10 and 12 patients underwent EUS-FNA and EUS-FNB, respectively. Compared to the EUS-FNA group, the EUS-FNB group had a significantly lower median number of needle passes to obtain macroscopically optimal core samples (4 vs. 2, p = 0.025); higher yield rates of macroscopically and histologically optimal core samples with three needle passes (30% vs. 92%, p = 0.006; 20% vs. 75%, p = 0.010, respectively); and a higher diagnostic sufficiency rate (20% vs. 75%, p = 0.010). No technical difficulties were encountered in either group. CONCLUSIONS. This study shows that EUS-FNB has a better ability to obtain histological core samples and a higher diagnostic sufficiency rate than EUS-FNA and that EUS-FNB is a feasible, safe, and preferable modality for adequate core sampling for histopathological diagnosis of GI SETs.

Untitled

“…Patients who were randomized to EUS-FNB had significantly higher diagnostic yield compared to patients who underwent EUS-FNA (75 % vs. 20 %, P = 0.010) [28]. Previously published prospective studies have also noted high diagnostic accuracy of the FNB technique in non-pancreatic mass lesions [23,35]. A recent study evaluated 125 patients with nonpancreatic masses using the 22-G core biopsy needle.…”

“…Data are limited from randomized controlled trials comparing EUS-FNA to EUS-FNB in non-pancreatic mass lesions. [35,36] The published diagnostic yield of EUS-FNA for gastric subepithelial masses ranges from 42 % to 92 % [37,38]. Recently, Kim et al conducted a randomized controlled trial of 22 patients with gastric subepithelial tumors.…”

Addition of Endoscopic Ultrasound (EUS)-Guided Fine Needle Aspiration and On-Site Cytology to EUS-Guided Fine Needle Biopsy Increases Procedure Time but Not Diagnostic Accuracy

“…In these cases, the lower diagnostic accuracy may be related to the need for histology to facilitate immunohistochemical staining or cellular architecture to solidify a final diagnosis. EUS with fine needle biopsy (FNB) has been recently shown to have a high diagnostic accuracy in these lesions 7,8…”

Endoscopic Ultrasound-Guided Fine Needle Biopsy without Rapid On-Site Cytologic Examination: A Time to Change the Paradigm?

“…However, in one study using a new EUS histology needle, the authors reported a correct diagnosis of 86% and an overall diagnostic accuracy for the detection of malignancy of 92.9% without a pathologist present for the endoscopy 14. A recent study by Kim et al6 reported that the yield of histologic core sample and diagnostic sufficiency rate of EUS-FNB was higher than that of EUS-FNA for histopathological diagnosis of SET of the GI tract in the absence of an onsite pathologist. In the current issue of Clinical Endoscopy, Keswani et al15 reported their retrospective study comparing the diagnostic accuracy of EUS-FNB alone to a conventional sampling method of EUS-FNA with rapid on-site cytology evaluation (ROSE) followed by EUS-FNB in nonpancreatic adenocarcinoma lesions.…”

“…The sensitivity of EUS-guided tissue acquisition decreases by 10% to 15%, the number of needle passes increases, and the overall procedure time is prolonged in the absence of an on-site pathologist 3,4. Second, for some GI tumors, including GI stromal tumors, cytology yield is limited, and core tissue is sometimes requested by cytopathologists to identify cellular arrangement and tissue architecture for adequate diagnosis and subtyping 5,6. These limitations lead to the need for large needles capable of obtaining core tissue.…”