Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study

Lee, Yun Nah; Moon, Jong Ho; Kim, Hee Kyung; Choi, Moon Han; Kim, Dong Choon; Lee, Tae Hoon; Cha, Sang‐Woo; Cho, Young Deok; Park, Sang‐Heum

doi:10.1055/s-0034-1377558

Cited by 142 publications

(160 citation statements)

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“…However, this study used suction during procurement of FNB, which may have increased the bloodiness and contamination of specimens. Two recently published prospective, randomized trials have also shown no difference in diagnostic yield between EUS-FNA and EUS-FNB for pancreas mass lesions [44,45]. Consistent with the previously published literature, results from this randomized controlled trial also showed no difference in diagnostic yield between EUS-FNA and EUS-FNB for pancreatic masses (FNB: 91.7 %, FNA: 78.4 %, P = 0.19).…”

Section: Discussionsupporting

confidence: 89%

Untitled

2016

Endosc Int Open

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Section: Discussionsupporting

confidence: 89%

Untitled

2016

Endosc Int Open

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“…The authors used both core biopsy and cytoblock for the diagnosis, so we do not know how much a contribution the core biopsy made by itself. A second study, focused on the 22G FNA standard needle, with a median of two passes, showed that the accuracy for histology was 82% and the sensitivity was only 81%, in the conditions of splitting samples for two cytology examinations and for histology, a fact which could diminish the diagnostic yield [20]. A similar accuracy (82.5%) was obtained in a third study with two passes of FNA.…”

Section: Discussionmentioning

confidence: 70%

Performance of the Standard 22G Needle for Endoscopic Ultrasound-guided Tissue Core Biopsy in Pancreatic Cancer

Seicean

Gheorghiu

Zaharia

et al. 2016

JGLD

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Background & Aim: Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are considered good tools for the diagnosis of pancreatic cancer and for obtaining material for cytology or histology. The accuracy of EUS-FNA can rise to 85-95%, but it is lower in cases with a chronic pancreatitis background or with previous biliary stenting. We aimed to establish the diagnostic yield of the visible length of the core biopsy samples in pancreatic cancer by using one single type of standard 22G needle and to evaluate the factors which can influence the results. Method: EUS-FNA was performed by using a 22G standard needle on patients prospectively recruited with the suspicion of pancreatic masses on transabdominal ultrasound or CT scan over a period of eight months. The number of passes was limited by the length of the core obtained. The final diagnosis was based on EUS-FNA or hepatic biopsy for their metastasis or by follow up every three month by imaging methods. Results: The study included 118 patients. Previous stents were present in 10 patients and chronic pancreatitis features were found in 3 patients. The procedure sensitivity was 89% and the global accuracy was 89%. The presence of biliary stents did not impede the accuracy of results. The number of passes did not influence the results. Conclusions: The diagnostic rate of core biopsy by using 22G needles had a high accuracy and it is safe when the length of core dictates the number of passes. The presence of biliary stents did not influence the results. Abbreviations: AUC: area under the curve; EUS: endoscopic ultrasonography; EUS-FNA: fine needle aspiration under endosonographic guidance; FNA: fine needle aspiration; INR: international normalised ratio; OR: odds ratio.

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“…This study also reported on high rates of IHC being performed on both the FNA (78%) and FNAB (83%) acquired tissue. 35 Although intuitively, one would expect higher tissue-grade material and diagnostic yield with these newer ProCore needles, the current randomized data from pancreatic masses show equivalency with regular FNA with respect to both diagnostic yield and overall histological tissue grade. However, there may be a trend toward fewer passes to establish the diagnosis using FNAB ProCore needles and hence shorter procedures times.…”

Section: Pancreas Eus-fnab With High-definition Core Biopsy Needlementioning

confidence: 92%

“…Interestingly, both pathologists found the overall sample quality significantly better for the standard FNA needle (expert 1, P = 0.009; expert 2, P = 0.002). 34 Finally, Lee et al 35 prospectively randomized 116 consecutive patients with solid pancreatic masses to EUS-FNAB using either a 22-gauge (transgastrically) or 25-gauge (transduodenally) FNAB ProCore biopsy needle or EUS-FNA using a standard aspiration 22-gauge (transgastrically) or 25-gauge (transduodenally) needle. A portion of the material obtained was smeared onto 3 to 5 glass slides for on-site analysis and Papanicolaou stain cytology, with the residual tissue placed into 2 or 3 wells of a tissue tray with formalin for histological analysis.…”

Section: Pancreas Eus-fnab With High-definition Core Biopsy Needlementioning

confidence: 99%

Endoscopic Ultrasound–Guided Pancreatic Core Biopsy

Farrell¹

2015

Pathology Case Reviews

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Routine endoscopic ultrasound (EUS)-guided biopsy of the pancreas typically utilizes fine-needle aspiration (FNA) to acquire a sample for cytologic analysis. The development of EUS-guided FNA biopsy techniques, which aims to obtain a histological core of tissue, has many potential benefits compared with EUS-FNA. The goals of this review are to review the need, indications, and techniques for EUS-FNA biopsy and review the current literature as it pertains to pancreatic disease.A 64-year-old man presented for evaluation of vague abdominal pain. Initial liver chemistries and CA-19-9 levels were normal. Computed tomography scan of the abdomen revealed a diffusely swollen pancreatic body and tail without a distinct mass. Given the suspicion for a benign pancreatic condition, endoscopic ultrasound evaluation was requested. At the time of endoscopic ultrasound, a diffusely hypoechoic pancreatic parenchyma with hyperechoic foci and irregular pancreatic duct intermittently was noted suggestive of chronic pancreatitis. Endoscopic ultrasoundguided fine-needle aspiration biopsy (EUS-FNAB) with 19-gauge TruCut biopsy (TCB) needle (Quick-Core; Wilson-Cook, Winston-Salem, NC) was performed 3 times with 2 cores of tissue retrieved and submitted for pathologic evaluation.All biopsies cores underwent routine histological processing of formalin fixation and paraffin embedding in a single block. Initial hematoxylin-eosin (H&E) levels revealed evidence of chronic pancreatitis, with features compatible with autoimmune pancreatitis (AIP) in the 1 visible core (Figs. 1A and B). However, additional deeper H&E levels revealed diagnostic evidence of invasive ductal adenocarcinoma in the second core, not present on initial levels (Figs. 1C and D). The patient subsequently underwent exploratory surgery within 2 weeks of the initial EUS evaluation, and the primary pancreatic ductal adenocarcinoma was deemed unresectable because of the presence of liver metastases.The current diagnostic yield for EUS-FNA cytology of pancreatic masses is high, better than for nonpancreatic indications, but not perfect. 1-5 There are several reasons for the suboptimal diagnostic results including variable operator-dependent EUS imaging and techniques, the lack of local available cytologic expertise, poor specimen cellularity, and lack of detail on the tissue architecture and morphology. This latter issue is particularly problematic for separating out well-differentiated pancreatic ductal adenocarcinoma from normal pancreatic tissue, as well as trying to diagnose pancreatic malignancy in the setting of chronic pancreatitis. 6,7 For example, it is very difficult to make a diagnosis of AIP using cytology alone, and the available histology allows for not only architecture but also semiquantitative immunohistochemistry (IHC) with immunoglobulin G4

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Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study

Abstract: The overall accuracy of FNB and FNA in patients with solid pancreatic masses was comparable; however, fewer passes were required to establish the diagnosis of malignancy using FNB.This study was registered on the UMIN Clinical Trial Registry (UMIN000014057).

Cited by 142 publications

References 20 publications

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Performance of the Standard 22G Needle for Endoscopic Ultrasound-guided Tissue Core Biopsy in Pancreatic Cancer

Endoscopic Ultrasound–Guided Pancreatic Core Biopsy

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