Slow-Pull Using a Fanning Technique Is More Useful Than the Standard Suction Technique in EUS-Guided Fine Needle Aspiration in Pancreatic Masses

Lee, Jae Min; Lee, Hong Sik; Hyun, Jong Jin; Lee, Jung Min; Yoo, In Kyung; Kim, Seung Han; Choi, Hyuk Soon; Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Chun, Hoon Jai; Um, Soon Ho; Kim, Chang Duck

doi:10.5009/gnl17140

Cited by 38 publications

(53 citation statements)

References 28 publications

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“…▶ Table 1 summarizes the characteristics of the seven included studies [10,11,[17][18][19][20][21]. They were all full-text RCTs published between 2017 and 2019; two were initially available only as abstracts from conferences' proceedings at the time of submission that during the revision process became available as full text and whose data were accordingly updated [20,21].…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Only two studies [10,20] were multicentric. Two studies were carried out in the US [10,11], 2 in Korea [18,19] and one each in Brazil [21], India [17] and Italy [20]. Different needles were employed, with 3 studies employing FNB needles [11,19,20] and 4 FNA [10,17,18,21]).…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Two studies were carried out in the US [10,11], 2 in Korea [18,19] and one each in Brazil [21], India [17] and Italy [20]. Different needles were employed, with 3 studies employing FNB needles [11,19,20] and 4 FNA [10,17,18,21]). Four of the studies randomized distinct individual patients with solid pancreatic lesions to either SU or SP sampling [10,11,17,20], for a total of 327 patients (164 SP, 163 SU); the remaining 3 studies [18,19,21] randomized the same patients with solid pancreatic lesions to both SU and SP sampling in a random order, for a total of 148 patients.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Four of the seven studies [11,[17][18][19] reported data on the diagnostic adequacy comparing SU and SP. Samples were considered adequate in case of "cytological aspirates or histological core tissue samples that were sufficient for diagnostic interpretation" [11], or if "adequate for the cytopathologist to make a diagnosis" [17], or if "sufficient amount of representative cells for pathological diagnosis" [18] was provided, while the definition was not clearly provided in one study [19]. There was no significant difference between the two techniques (▶ Fig.…”

Section: Diagnostic Adequacymentioning

confidence: 99%

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Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials

2020

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Background and study aims Current ESGE guidelines suggest employing the suction (SU) technique for endoscopic ultrasound (EUS)-guided sampling of pancreatic solid lesions. Nonetheless, recent randomized controlled trials (RCT) have reported that the slow-pull (SP) technique has similar diagnostic accuracy with possibly less blood contamination. However, these results are heterogeneous and limited to small cohorts. The aim of this meta-analysis was to compare adequacy, accuracy, sensitivity and specificity of the SU and SP techniques for EUS-guided sampling of solid pancreatic lesions. Methods A computerized bibliographic search was restricted to RCTs. Pooled effects were calculated using a random-effects model and expressed in terms of pooled sensitivity and specificity and OR (95 % CI) for adequacy and accuracy. Results Overall, seven RCTs were included, for a total of 475 patients (163 lesions sampled with SU, 164 with SP and 148 by both). The adequacy was similar (OR = 0.98) without heterogeneity (I2 = 0 %), but a high degree of blood contamination was more common with SU than SP (pooled rate 27.6 % vs 19.7 %). A non-significant superiority of SP in terms of pooled accuracy (OR = 0.82; 95 % CI 0.36–1.85) was recorded, with moderate heterogeneity (I2 = 52.4 %). The SP technique showed a slightly higher pooled sensitivity compared to SU (88.7 % vs 83.4 %), while specificity was similar (97.2 % SP vs 96.9 % SU), with considerable heterogeneity. Conclusion The current meta-analysis reveals non-superiority of SU over SP, while SP results in reduced blood contamination. If the 5 % accuracy difference favouring SP is true, with alfa error = 0.05 and beta = 0.20, a RCT of 982 patients per arm is needed to confirm significance.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Diagnostic Adequacymentioning

confidence: 99%

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Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials

2020

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“…16 Lee and colleagues also found that the slow-pull capillary technique had a higher diagnostic yield than the suction technique in pancreatic disease. 17 Although the slow-pull capillary technique is increasingly being used for the diagnosis of digestive diseases, there is currently no evidence regarding its use in respiratory diseases. Therefore, the aim of this study was to compare the diagnostic accuracy of EBUS-TBNA using the suction technique and the slow-pull capillary technique.…”

Section: Introductionmentioning

confidence: 99%

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Wang

et al. 2020

Ther Adv Respir Dis

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely used, safe, and accurate technique for obtaining pathological specimens to be used in the diagnosis of diseases involving lung hilar and mediastinal lymph node (LN) enlargement. However, application of the suction technique during EBUS-TBNA remains controversial. In addition, the effectiveness of the slow-pull capillary technique for the diagnosis of pancreatic masses was recently reported. The aim of this study was to compare the diagnostic accuracy of EBUS-TBNA using these two techniques. Methods: The accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and availability of tissue cores of the suction and slow-pull capillary techniques were studied retrospectively in patients who underwent EBUS-TBNA for the diagnosis of diseases involving lung hilar and mediastinal LN enlargement. Results: A total of 97 patients with hilar and mediastinal LN enlargement underwent EBUS-TBNA; 30 patients underwent the suction technique, 56 patients underwent the slow-pull capillary technique, 5 patients underwent both techniques, and 6 patients had failed operations. The accuracy, sensitivity, specificity, NPV, PPV, and the number of tissue cores obtained with the suction and slow-pull capillary techniques were 66.67% versus 85.71% ( p = 0.039), 43.75% versus 85.42% ( p < 0.001), 92.86% versus 87.5% ( p > 0.05), 59.09% versus 50% ( p > 0.05), 87.5% versus 97.62% ( p > 0.05), and 19 versus 50 ( p = 0.004), respectively. In both univariate and multivariate analyses, the acquisition of tissue core was significantly associated with the diagnostic accuracy of EBUS-TBNA. Moreover, the slow-pull capillary technique was significantly associated with the acquisition of tissue core in EBUS-TBNA. There were no significant differences between the two groups in the blood contamination of samples. Conclusions: Use of the slow-pull capillary technique in EBUS-TBNA can significantly increase the accuracy related to the diagnosis of diseases involving hilar and mediastinal LN enlargement by improving the acquisition of tissue core. The reviews of this paper are available via the supplemental material section.

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Comparison of the slow‐pull and aspiration methods of endobronchial ultrasound‐guided transbronchial needle aspiration for next‐generation sequencing‐compatible tissue collection in non‐small cell lung cancer

Kajita,

Teranishi,

Sawazumi

et al. 2023

Cancer Medicine

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BackgroundPersonalized treatment for non‐small cell lung cancer (NSCLC) has advanced rapidly, and elucidating the genetic changes that trigger this disease is crucial for appropriate treatment selection. Both slow‐pull and aspiration methods of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) are accepted methods for collecting samples suitable for next‐generation sequencing (NGS) to examine driver gene mutations and translocations in NSCLC. Here, we aimed to determine which of these two methods is superior for obtaining higher‐quality samples from patients with NSCLC.MethodsSeventy‐one patients diagnosed with NSCLC via EBUS‐TBNA using the slow‐pull or aspiration (20‐mL negative pressure) methods between July 2019 and September 2022 were included. A total of 203 tissue samples from the 71 patients were fixed in formalin, embedded in paraffin, and mounted on slides. The presence of tissue cores, degree of blood contamination, and number of tumor cells were compared between the groups. The success rate of NGS, using Oncomine Dx Target Test Multi‐CDx, was also compared between the groups.ResultsThe slow‐pull method was associated with a higher yield of tissue cores, lower degree of blood contamination, and higher number of tumor cells than the aspiration method. The success rate of the NGS was also significantly higher for the slow‐pull group (95%) than for the aspiration group (68%).ConclusionOverall, these findings suggest that the slow‐pull method is a superior technique for EBUS‐TBNA to obtain high‐quality tissue samples for NGS. The slow‐pull method may contribute to the identification of driver gene mutations and translocations and facilitate personalized treatment of NSCLC.

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Slow-Pull Using a Fanning Technique Is More Useful Than the Standard Suction Technique in EUS-Guided Fine Needle Aspiration in Pancreatic Masses

Cited by 38 publications

References 28 publications

Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials

Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials

Slow-pull capillary technique versus suction technique in endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing diseases involving hilar and mediastinal lymph node enlargement

Comparison of the slow‐pull and aspiration methods of endobronchial ultrasound‐guided transbronchial needle aspiration for next‐generation sequencing‐compatible tissue collection in non‐small cell lung cancer

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