Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been established as a method to obtain tissues of various organs. To obtain sufficient tissue has clinical impact to facilitate the diagnosis by clinical pathologists, the assessment and subtyping of various neoplasms, and for further immunohistochemical investigations of tumor type. Recently, a novel 20G core trap with a forward-cutting beveled FNA needle (ProC-F) has become available. The aim of this prospective study was to evaluate the feasibility and diagnostic yield of EUS-FNA for pancreatic lesions using this needle.
Patients and Method
In this study, the first puncture was performed using the ProC-F. Only tissue obtained with the first puncture using the ProC-F was used to evaluate diagnostic yield of ProC-F. The second puncture was performed using a 22G standard FNA needle using the same technique as for the first puncture. Second puncture was performed if the endosonographer did not feel that sufficient tissue had not been obtained by first puncture.
Fifty-three consecutive patients who underwent EUS-FNA for pancreatic lesions were prospectively enrolled. The technical success rate of EUS-FNA using the ProC-F was 98.1% (52/53). The rate of adequate tissue obtained by ProC-F was 96.2% (50/52). On the other hand, the rate of adequate tissue obtained by the standard needle was 71.1%. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of the ProC-F and the standard needle were 92.5, 100, 100, 76.9, and 94.0%, and 85.2, 100, 100, 55.6, and 87.5%, respectively. Diagnostic yield of ProC-F about sensitivity (P = 0.027), NPV (P = 0.035), and accuracy (P = 0.004) was significantly higher than of standard needle. Adverse events were not seen in any patients.
Although only tissue obtained by the first puncture was evaluated, the rate of adequate tissue and the histologic diagnostic yield for pancreatic lesions were extremely high using the ProC-F.
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Onda S, Ogura T, Kurisu Y et al (2016) EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence. Therap Adv Gastroenterol 9:302–312
Soh JS, Lee HS, Lee S et al (2015) The clinical usefulness of endoscopic ultrasound-guided fine needle aspiration and biopsy for rectal and perirectal lesions. Intest Res 13:135–144
Kurita A, Kodama Y, Nakamoto Y et al (2016) Impact of EUS-FNA for preoperative para-aortic lymph node staging in patients with pancreatobiliary cancer. Gastrointest Endosc 84:467–475
Lopes RI, Moura RN, Artifon E (2015) Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of kidney lesions: a review. World J Gastrointest Endosc 16:253–257
Pineda JJ, Diehl DL, Miao CL et al (2016) EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route. Gastrointest Endosc 83:360–365
Itoi T, Sofuni A, Itokawa F et al (2011) Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions. Dig Endosc 23:17–21
Chen G, Liu S, Zhao Y et al (2013) Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a meta-analysis. Pancreatology 13:298–304
Hewitt MJ, McPhail MJ, Possamai L et al (2012) EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 75:319–331
Nakai Y, Isayama H, Chang KJ et al (2014) Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses. Dig Dis Sci 59:1578–1585
Attam R, Arain MA, Bloechl SJ et al (2015) “Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc 81:1401–1407
Ramesh J, Bang JY, Mebert-Magee S et al (2015) Randomized trial comparing the flexible 19G and 25G needles for endoscopic ultrasound-guided fine needle aspiration for solid pancreatic mass lesions. Pancreas 44:128–133
Affolter KE, Schmidt RL, Matynia AP et al (2013) Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: a systematic review and meta-analysis. Dig Dis Sci 58:1026–1034
Varadarajulu S, Fraig M, Schmulewitz N et al (2004) Comparison of EUS-guided 19-gauge trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 36:397–401
Levy MJ, Jondal ML, Clain J et al (2003) Preliminary experience with EUS-guided trucut biopsy needle compared with EUS-guided FNA. Gastrointest Endosc 57:101–106
Alatawi A, Beuvon F, Grabar S et al (2015) Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United Eur Gastroenterol J 3:343–352
Kamata K, Kitano M, Yasukawa S et al (2016) Histologic diagnosis of pancreatic masses using 25-gauge endoscopic ultrasound needles with and without a core trap: a multicenter randomized trial. Endoscopy 48:632–638
Rodrigues-Pinto E, Jalaji S, Grimm IS et al (2016) Impact of EUS-guided fine-needle biopsy sampling with a new core needle on the need for onsite cytopathologic assessment: a preliminary study. Gastrointest Endosc 84:1040–1046
Kandel P, Tranesh G, Nassar A et al (2016) EUS-guided fine needle biopsy sampling using a novel fork-tip needle: a case-control study. Gastrointest Endosc 84:1034–1039
Ishiwatari H, Hayashi T, Kawakami H et al (2016) Randomized trial comparing a side-port needle and standard needle for EUS-guided histology of pancreatic lesions. Gastrointest Endosc 84:670–678
Cotton PB, Eisen GM, Aabakken L et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:746–754
Paik WH, Park Y, Park DH et al (2015) Prospective evaluation of new 22 gauge endoscopic ultrasound core needle using capillary sampling with stylet slow-pull technique for intra-abdominal solid masses. J Clin Gastroentrol 49:199–205
Matynia AP, Schmidt RL, Barraza G et al (2014) Impact of rapid on-site evaluation on the adequacy of endoscopic-ultrasound guided fine-needle aspiration of solid pancreatic lesions: a systematic review and meta-analysis. J Gastroenterol Hepatol 29:697–705
Fabbri C, Fuccio L, Fornelli A et al (2017) The presence of rapid on-site evaluation did not increase the adequacy and diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions with core needle. Surg Endosc 31:225–230
Ogura T, Yamao K, Sawaki A et al (2012) Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses. Gastrointest Endosc 75:769–774
Wani S, Shah RJ (2016) EUS-guided tissue acquisition: do we need to shoot for a “core” to score? Gastrointest Endosc 84:1047–1049
Paquin SC, Gariepy G, Lepanto L et al (2005) A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc 61:610–611
Katanuma A, Maguchi H, Hashigo S et al (2012) Tumor seeding after endoscopic ultrasound-guided fine-needle aspiration of cancer in the body of the pancreas. Endoscopy 44:E160–E161
Nobu Nishiok, Takeshi Ogura, Yoshitaka Kurisu, Miyuki Imanishi, Saori Onda, Wataru Takagi, Tatsushi Sano, Atsushi Okuda, Akira Miyano, Mio Amano, and Kazuhide Higuchi declare that there are no conflict of interest or financial ties to disclose.
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Nishioka, N., Ogura, T., Kurisu, Y. et al. Prospective histological evaluation of a 20G core trap with a forward-cutting bevel needle for EUS-FNA of pancreatic lesions. Surg Endosc 32, 4125–4131 (2018). https://doi.org/10.1007/s00464-018-6155-7
- Endoscopic ultrasound
- Endoscopic ultrasound-guided fine needle aspiration
- Forward-cutting bevel needle
- Pancreatic cancer