EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study

Larghi, Alberto; Verna, Elizabeth C.; Ricci, Riccardo; Seerden, Tom; Galasso, Doménico; Carnuccio, Antonella; Uchida, Naoshige; Rindi, Guido; Costamagna, Guido

doi:10.1016/j.gie.2011.05.014

Cited by 100 publications

(91 citation statements)

References 34 publications

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“…Three studies have been able to obtain adequate histological samples by using the 19-gauge standard cytology needle. yasuda et al (29) could obtain histological samples with the standard needle in almost every evaluated patient, with an overall diagnostic accuracy of 98 %, but by doing more than one pass. In addition, only FNA from lymph nodes were included in that study, what cannot be directly compared to pancreatic lesions (29).…”

Section: Discussionmentioning

confidence: 99%

“…yasuda et al (29) could obtain histological samples with the standard needle in almost every evaluated patient, with an overall diagnostic accuracy of 98 %, but by doing more than one pass. In addition, only FNA from lymph nodes were included in that study, what cannot be directly compared to pancreatic lesions (29). In our series, we have not only included lymph nodes from various locations (obtaining a similar accuracy with less passes), but also 33 pancreatic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Although biopsy with quick-Core ® needle has no (1) clear advantage over EUS-FNA in terms of overall sensitivity and diagnostic accuracy, it does provide with a more specific diagnosis in selected cases with less needle passes (29,37,44). A combination of EUS-biopsy with quickCore ® needle and EUS-FNA has shown a higher overall diagnostic yield than any of the two needles alone (45)(46)(47).…”

Section: Discussionmentioning

confidence: 99%

“…Various EUS-guided techniques have been explored to retrieve tissue specimens, including FNA and Tru-Cut needles, with variable success and complication rates (25)(26)(27)(28)(29)(30)(31)(32). of particular interest is the quick-Core ® needle, designed to operate through an echoendoscope.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Iglesias‐García

Abdulkader

Lariño‐Noia

et al. 2014

Rev. esp. enferm. dig.

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Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an accurate technique for sampling intraintestinal and extraintestinal lesions. However, cytology possesses certain limitations, which may be overcome if histological specimens are provided to the pathologist.Aim: The aim of the study was to evaluate the accuracy of a newly developed 19G histology needle.Methods: Retrospective analysis of a prospectively collected data base including patients who underwent EUS-guided biopsy with the 19G ProCore TM histology needle for the evaluation of intraintestinal or extraintestinal lesions. Samples were obtained after one needle pass, recovered into ThinPrep ® and processed for histological analysis. Results were compared to the gold standard of surgical histopathology, or global pathological, clinical and radiological assessment, and follow-up in non-operated cases. Results are shown as mean ± SD. Percentage of optimal samples for histological evaluation and the overall diagnostic accuracy were evaluated.Results: 87 patients (mean age 62.9 years, range 25-88 years, 36 woman) were included. Lesions mean size was 41.6 ± 21.3 mm. 66 lesions (75.9 %) were considered as malignant and 21 (24.1 %) as benign. EUS-guided biopsy was feasible in all cases (100 %). Sample quality was adequate for histological assessment in 82 lesions (94.2 %). In the remaining cases the sample was adequate for cell-block evaluation. Sensitivity, specificity, PPV, NPV, and overall accuracy for malignancy were 93.4 %, 100 %, 100 %, 84 %, and 95.4 %, respectively. There were no complications related to the procedure. Conclusion:The EUS-guided biopsy with the 19G histology needle provides with an optimal core sample for histological evaluation allowing a high histopathologic diagnostic accuracy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Iglesias‐García

Abdulkader

Lariño‐Noia

et al. 2014

Rev. esp. enferm. dig.

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“…6 However, patients with pancreatic head or uncinate masses were excluded in this study. A major limitation of the 19G needle has been its rigidity that makes transduodenal sampling of pancreatic masses difficult because of the stiffness induced by the needle assembly on the echoendoscope shaft.…”

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confidence: 99%

Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions

2016

Pancreas

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Objectives: Although a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), its advantage over smaller needles is unclear. This study compared flexible 19G and 25G needles for EUS-FNA of solid pancreatic masses.Methods: This was a randomized trial of patients undergoing EUS-FNA of pancreatic masses using flexible 19G or 25G needle. Main outcome measure was to compare median number of passes for on-site diagnosis. Secondary measures were to compare specimen bloodiness, complications, technical failures, and histological core tissue procurement.Results: One hundred patients were randomized to EUS-FNA using flexible 19G or 25G needle. Median of 1 pass was required to achieve on-site diagnosis of 96% and 92% (P = 0.68) in 19G and 25G cohorts. There was no significant difference in technical failure (0% vs 2%, P = 0.99) or adverse events (2% vs 0%, P = 0.99) between 19G and 25G cohorts. Although histological core tissue procurement was significantly better with flexible 19G needle (88% vs 44%, P < 0.001), specimens were bloodier (severe bloodiness, 36% vs 4%; P < 0.001). Conclusions:As there is no significant difference in the performance of flexible 19G and 25G needles, needle choice for sampling pancreatic masses should be based on endoscopist preference and need for histology.Key Words: EUS-FNA, solid pancreatic mass, pancreatic cancer, pancreatic biopsy, flexible 19G needle, randomized trial (Pancreas 2015;44: 128-133) E ndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an integral part of the diagnostic algorithm for the evaluation of solid pancreatic mass lesions. Randomized trials have compared the 25G, 22G, and 19G needles in an attempt to identify the optimal needle for tissue acquisition.1-3 Of the 3 studies that compared the 22G and 25G needles, 1-3 whereas there was no significant difference in diagnostic accuracy, there was a trend toward better performance with the 25G needle for the FNA of pancreatic head masses. These findings were confirmed in a recent meta-analysis that revealed higher sensitivity of 25G over 22G needles for the EUS-FNA of pancreatic mass lesions. 4A limitation of FNA procedures, particularly when using smaller gauge (22G or 25G) needles, is the limited ability to procure adequate histological samples. Tissue architecture and morphology are essential for accurate pathological assessment of certain lesions, such as lymphomas and gastrointestinal stromal tumors, for which histological core is preferred over a cytological aspirate. 5 Although a larger 19G needle can procure histological samples, published data are limited.6-8 In a study of 120 patients who underwent EUS-FNA using the 19G needle, the procedure was technically successful in 98.9%, and adequate histological sample was obtained in 97.5%. 6 However, patients with pancreatic head or uncinate masses were excluded in this study. A major limitation of the 19G needle has been its rigidity that makes transduodenal sampling of pancreatic masses difficult beca...

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EUS‐guided 22‐gauge fine‐needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms

Strand

Jeffus

Sauer

et al. 2014

Diagnostic Cytopathology

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Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used for diagnosis of pancreatic lesions. The Echotip Procore Needle (Wilson-Cook Medical) is a new 22G fine biopsy needle (FNB) for obtaining core biopsy material at time of EUS. This study aimed to compare the technical and diagnostic performance of conventional FNA and FNB. Thirty-two patients met the design criteria for this prospective paired cohort study. All lesions sampled were solid (non-cystic) pancreatic masses by EUS appearance. Patients were randomized to receive FNA or FNB by first attempt. A cytopathologist performed on-site evaluations. Samples were assessed for accuracy of diagnosis, cellularity, contamination, and sufficiency for ancillary studies. Technical and diagnostic performances were compared. Compared to FNA, there was a statistically significant decreased ability of FNB to achieve a diagnosis (FNA 93.8%, FNB 28.1%, P < 0.001). FNB was diagnostically superior to FNA in 1 of 32 cases. Technical failures were observed in five cases due to resistance to advancement of the FNB needle. Regarding operator perceived ease-of-use, FNA outperformed FNB (P < 0.001). Eight cases had insufficient FNB material to survive tissue processing. There was no significant difference in mean specimen cellularity between devices. FNA samples showed an increased amount of contaminant (P = 0.036) but were more sufficient for ancillary studies (P = 0.502). Although deemed comparable to FNA when providing material for cytology, the pledged advantage of FNB acting like a core biopsy needle was not apparent in our series. Additional studies are needed before routine adoption of 22G FNB can be recommended.

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EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study

Cited by 100 publications

References 34 publications

Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Evaluation of the adequacy and diagnostic accuracy of the histology samples obtained with a newly designed 19-gauge EUS histology needle

Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions

EUS‐guided 22‐gauge fine‐needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms

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