Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

Abstract

Background and study aims: Although Endoscopic Ultrasound (EUS)-guided tissue sampling is widely used, the optimal sampling strategy remains subject of debate. We evaluated practice patterns within the international endosonographic community. Patients and methods: An online questionnaire was sent to 400 endosonographers from the United States, Europe, and Asia. Results: A total of 186 (47 %) endosonographers participated: United States 54 (29 %), Europe 85 (46 %), and Asia 47 (25 %). European (75 %) and Asian (84 %) respondents routinely check coagulation status, whereas US respondents only check on indication (64 %, P = 0.007). While propofol sedation is standard in the United States (83 %), conscious sedation is still widely used in Europe (52 %) and Asia (84 %, P < 0.001). Overall, the 22-gauge needle is most commonly used (52 %). For fine-needle aspiration (FNA) of solid pancreatic lesions, 22-gauge (45 %) and 25-gauge (49 %) needles are used equally. For fine-needle biopsy (FNB) of solid masses, the 25-gauge device is less favored than the 22-gauge FNA device (49 % versus 21 %). The 19-gauge needle is generally used for FNB of submucosal masses (62 %). Rapid on-site pathological evaluation (ROSE) is utilized more often by US (98 %) than by European and Asian respondents (51 %, P < 0.001). Cytolyt (52 %), formalin (15 %) and alcohol (15 %) are used for FNA specimen preservation in the United States and Europe, while saline (27 %) and alcohol (38 %) are widely used in Asia (P < 0.001). Conclusions: EUS-guided tissue sampling practices vary substantially within the international endosonographic community and differ considerably from recommendations expressed in guidelines. Because the clinical relevance of these variations is largely unknown, the outcome of this survey suggests a need for further studies.

Cross-Sectional Study to Assess Endoscopic Ultrasound Practice in Portugal

“…In our survey, the cell block technique is applied in all echoendoscopy units which performed EUS-FNA. These data are in line with the results of van Riet et al [6] which demonstrated that the majority of respondents applied the cell block technique (85%), but it was used to a lesser extent in Europe (85%) and Asia (70%) than in the United States (96%). DOI: 10.1159/000495524 Also noteworthy is the general involvement of at least 1 ultrasonographer in multidisciplinary meetings (61.9%) and the existence of a local EUS database (57.1%).…”

“…van Riet PA et al showed only half of the European and Asian respondents used ROSE. In this study, respondents who refrain from using ROSE consider limited pathology staff (74%) and disbelieve in its additive value (32%) as the main reasons for omitting it [6]. These data were corroborated by DiMaio et al [8] in a survey study which demonstrated that the vast majority of American ultrasonographers (76.2%) utilize ROSE when performing EUS-FNA.…”

“…In the 2006 Asian survey, the respondents had a median experience of 5 years (range 0-17) in EUS practices and performed a median of 500 procedures (range 3-6,000) in their career [2]. However, in 2016, van Riet et al [6] proposed to evaluate practice patterns within the international endosonographic community and revealed that most of the international respondents performed > 300 EUS (58%) and > 100 EUS-FNA procedures per year (68%).…”

“…In our study, air drying (50%) and formalin (50%) are most frequently used to fix and preserve smears, respectively. van Riet et al [6] showed that after EUS-FNA, a majority of the ultrasonographers air dried (43%) and used formalin to preserve FNA specimens (62%).…”

Rapid on-site evaluation of cytology for EUS- and EBUS-guided fine-needle aspiration

“…This has led to the establishment of ROSE as the default practice in many institutions where EUS-FNA or EBUS-FNA is offered. A survey of endosonologists indicated that ROSE was used more often by US (98%) than by European (48%) or Asian (55%) respondents [10].…”