Multicenter, randomized comparison of the diagnostic accuracy of 19‐gauge stainless steel and nitinol‐based needles for endoscopic ultrasound‐guided fine‐needle biopsy of solid pancreatic masses

Abstract

Background The use of 19-gauge (G) stainless steel needles for endoscopic ultrasound-guided fine-needle biopsy of a pancreatic mass often results in technical difficulties due to an inability to advance the relatively rigid needle out of the endoscope. More flexible nitinol-based needles might decrease such technical difficulties and thus increase diagnostic accuracy. Objective In this prospective multicenter randomized single-blinded study we compared the diagnostic value of those two needle types in patients with a solid pancreatic lesion. Methods Patients with a solid pancreatic mass were diagnosed with endoscopic ultrasound-guided fine-needle biopsy using one puncture with each needle in a randomized fashion. The primary endpoint was the diagnostic accuracy of each needle. Secondary endpoints included time for puncture, amount of tumour tissue obtained, and technical failure. Histological specimens were centrally reviewed by a pathologist blinded to the final needle type and final diagnosis (ClinicalTrials.gov Identifier: NCT02909530). Results Out of 46 prospectively recruited patients, central pathological examination was available for 41. Diagnostic accuracy for the two needles combined was 87.8%. Diagnostic accuracy was 66% and 68% using the stainless steel- and nitinol-based needle respectively. Time spent for puncturing was 137 ± 61 s (mean ± standard deviation) for the stainless steel and 111 ± 53 s for the nitinol-based needle ( p = 0.037). Technical failure occurred in three (6.5%) cases using the stainless steel- and in none using the nitinol-based needle. Conclusions Usage of a nitinol-based 19-G needle failed to present a significant superior accuracy compared with a stainless steel needle in endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions.

UEGWeek: The modern School of Athens

“…In a randomized trial on 46 patients, two 19G needles were employed: a nitinol‐based and a stainless steel one. The diagnostic accuracy was similar for both needles, with a slight reduction in time spent for puncturing for nitinol‐based needle 8 …”

“…The diagnostic accuracy was similar for both needles, with a slight reduction in time spent for puncturing for nitinol-based needle. 8 © 2021 The Authors. UEG Journal published by Wiley Periodicals LLC.…”

“…Among the almost 6000 abstracts submitted to 2019 and 2020 UEGWeek editions, 32 were then accepted as full‐text publication to UEG Journal 1–31 . Here we will summarize these “hot” papers (see also Figure 3).…”

Diagnosis by Endoscopic Ultrasonography-Guided Sampling through the Lower Gastrointestinal Tract

“…Benchtop tests conducted by Itoi et al proved that, in contrast to traditional 19G needles, 19G nitinol needles can be inserted at the optimal angle with minimal resistance under various endoscope bending conditions [ 41 ]. A multicenter, prospective, randomized, double-blind study of EUS-FNB needles applied to solid pancreatic masses by Hann et al showed no significant difference in diagnostic rates between 19G stainless-steel needles (65.9%) and 19G nitinol needles (68.3%) ( p = 0.73) [ 42 ]. However, nitinol needles reduce the puncture time and technical failure rate (i.e., the needle cannot be bent or inserted twice).…”