Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses
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Prior to withdrawing the EUS-FNA needle from the lesion, the stopcock of the suction syringe is closed to reduce contamination. Residual negative pressure (RNP) may persist in the needle despite closing the stopcock.
To determine whether neutralizing RNP before withdrawing the needle will improve the cytology yield.
Bench-top testing was done to confirm the presence of RNP followed by a prospective, randomized, cross-over study on patients with pancreas mass. Ten milliliters of suction was applied to the FNA needle. Before withdrawing the needle from the lesion, the stopcock was closed. Based on randomization, the first pass was done with the stopcock either attached to the needle (S+) or disconnected (S−) to allow air to enter and neutralize RNP and accordingly the second pass was crossed over to S+ or S−. On-site cytopathologist was blinded to S+/S−.
Bench tests confirmed the presence of RNP which was successfully neutralized by disconnecting the syringe (S−) from the needle. Sixty patients were enrolled, 120 samples analyzed. S+ samples showed significantly greater GI tract contamination compared to S− samples (16.7 vs. 6.7 %, p = 0.03). Of the 53 patients confirmed to have pancreas adenocarcinoma, FNA using S− approach was positive in 49 (93 %) compared to 40 using the S+ approach (76 %, p = 0.02).
Despite closing the stopcock of the suction syringe, RNP is present in the FNA needle. Neutralizing RNP prior to withdrawing the needle from the target lesion significantly decreased GI tract contamination of the sample thereby improving the FNA cytology yield.
Clinical Trials Registration Number
KeywordsEndoscopic ultrasound (EUS) Tissue acquisition Fine needle aspiration (FNA) Pancreas mass Pancreas adenocarcinoma
Fine needle aspiration
Syringe-on; the suction syringe with its stopcock closed still attached to the needle handle
Syringe-off; the suction syringe with its stopcock closed disconnected from the needle handle
Minus (negative pressure)
This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number 8UL1TR000055. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Supplementary material 1 (WMV 49176 kb)
Supplementary material 2 (WMV 26989 kb)
- 4.Yusuf TET, Ho SS, Pavey DAD, Michael HH, Gress FGF. Retrospective analysis of the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic masses, using a 22-gauge or 25-gauge needle system: a multicenter experience. Endoscopy. 2009;41:445–448.CrossRefPubMedGoogle Scholar
- 9.Lee JK, Choi JH, Lee KH, et al. A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses. Gastrointest Endosc. 2013 Feb 21.Google Scholar
- 11.Mitsuhashi T, Ghafari S, Chang CY, Gu M. Endoscopic ultrasound-guided fine needle aspiration of the pancreas: cytomorphological evaluation with emphasis on adequacy assessment, diagnostic criteria and contamination from the gastrointestinal tract. Cytopathology. 2006;17:34–41.CrossRefPubMedGoogle Scholar
- 16.Woolf KMW, Liang H, Sletten ZJ, Russell DK, Bonfiglio TA, Zhou Z. False-negative rate of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid and cystic lesions with matched surgical resections as the gold standard: one institution’s experience. Cancer Cytopathol. 2013;121:449–458.CrossRefPubMedGoogle Scholar
- 27.Wani S, Mullady D, Early DS, Rastogi A, Collins B. Clinical impact of immediate on-site cytopathology (CyP) evaluation during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass: Interim analysis of a multicenter randomized con- trolled trial. Gastrointest Endosc. 2013;77:2. (Abstract supplement).CrossRefGoogle Scholar