Puncture of Solid Pancreatic Tumors Guided by Endoscopic Ultrasonography: A Pilot Study Series Comparing Trucut and 19-Gauge and 22-Gauge Aspiration Needles

Itoi, Takao; Itokawa, Fumihide; Sofuni, Atsushi; Nakamura, Kazuto; Tsuchida, Akira; Yamao, K.; Kawai, Takashi; Moriyasu, Fuminori

doi:10.1055/s-2004-826156

Cited by 104 publications

(109 citation statements)

References 9 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…In addition, another way to improve the sampling might be the use of larger needles. Nevertheless, 19-gauge needles could also increase the occurrence of complications, which should be evaluated in randomized clinical trials [19] .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

Ardengh¹,

Lopes²,

Lima³

et al. 2007

WJG

View full text Add to dashboard Cite

AIM:To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%. METHODS:CONCLUSION: EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

Ardengh¹,

Lopes²,

Lima³

et al. 2007

WJG

View full text Add to dashboard Cite

show abstract

“…170 The accuracy of EUS-CNB for the diagnosis of pancreatic malignancy has been lower (61%) than that of EUS-FNA (69%), even though all lesions were larger than 2 cm. 171 Two studies that combined EUS-FNA and EUS-CNB showed a low diagnostic yield of pancreatic EUS-CNB, but a better tissue sampling and overall diagnostic accuracy when the 2 methods were combined. 172,173 Both techniques had similar low rates of minor complications.…”

Section: Eus-cnbmentioning

confidence: 98%

“…EUS-CNB might also provide useful information for gene or immuno-histochemical analysis by providing a core biopsy, especially in the cases of well-differentiated tumors and tumors with substantial desmoplasia. [170][171][172][173] …”

Section: Eus-cnbmentioning

confidence: 99%

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

Săftoiu

Vilmann

2008

J of Clinical Ultrasound

View full text Add to dashboard Cite

Early diagnosis of pancreatic cancer remains a difficult task, and multiple imaging tests have been proposed over the years. The aim of this review is to describe the current role of endoscopic ultrasound (EUS) for the diagnosis and staging of patients with pancreatic cancer. A detailed search of MEDLINE between 1980 and 2007 was performed using the following keywords: pancreatic cancer, endoscopic ultrasound, diagnosis, and staging. References of the selected articles were also browsed and consulted. Despite progress made with other imaging methods, EUS is still considered to be superior for the detection of clinically suspected lesions, especially if the results of other cross-sectional imaging modalities are equivocal. The major advantage of EUS is the high negative predictive value that approaches 100%, indicating that the absence of a focal mass reliably excludes pancreatic cancer. The introduction of EUS-guided fine needle aspiration allows a preoperative diagnosis in patients with resectable cancer, as well as a confirmation of diagnosis before chemoradiotherapy for those that are not. This comprehensive review highlighted the diagnostic capabilities of EUS including the newest refinements such as contrast-enhanced EUS, EUS elastography, and 3-dimensional EUS. The place of EUSguided biopsy is also emphasized, including the addition of molecular marker techniques.

show abstract

“…Other studies that have evaluated the 19G needle for tissue acquisition report no adverse events associated with its use. [6][7][8]12 In a recent meta-analysis that compared the 19G versus 22G/25G needles for EUS-FNA of solid pancreatic mass lesions, there was no difference in the rates of complications between the 2 cohorts. 18 There are several limitations to our study.…”

Section: Discussionmentioning

confidence: 99%

“…In a comparative study that evaluated the 19G Trucut, 19G, and 22G FNA needles for sampling solid pancreatic mass lesions, the technical success rates for sampling uncinate lesions were 0% versus 0% versus 100% and, for head lesions, were 60% versus 60% versus 100%, respectively. 12 In a prospective randomized trial that compared the 19 and 22G needles, the technical success rate for sampling pancreatic head masses was significantly lower for the 19G needle than for the 22G needle (80.8% vs 100%). 7 In another study that evaluated the 19G needle, although FNA of pancreatic uncinate lesions was not feasible in any patient, the success rate for FNA of head lesions was only 33.3%.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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...

show abstract

Puncture of Solid Pancreatic Tumors Guided by Endoscopic Ultrasonography: A Pilot Study Series Comparing Trucut and 19-Gauge and 22-Gauge Aspiration Needles

Cited by 104 publications

References 9 publications

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

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

Contact Info

Product

Resources

About