A prospective randomized trial of EUS-guided tissue acquisition using a 25-gauge core biopsy needle with and without a stylet
Endoscopic ultrasound (EUS)-guided tissue acquisition has become the most effective method of obtaining specimens from a solid lesion adjacent to the gastrointestinal tract. No data exist regarding the use of a stylet in the core biopsy needle during EUS-guided tissue acquisition. The aims of this study were to evaluate the feasibility, safety, and diagnostic yield of a 25-gauge core biopsy needle without (S−) a stylet and to compare its performance with that of a 25-gauge core biopsy needle with (S+) a stylet in patients with solid lesions adjacent to the gastrointestinal tract.
From November 2013 to January 2016, we performed 114 EUS-guided tissue acquisitions for the diagnosis of solid lesions adjacent to the gastrointestinal tract in a randomized controlled trial. Patients were randomly assigned to the S+ group (n = 57) or the S− group (n = 57). EUS-guided tissue acquisition was performed using a 25-gauge core biopsy needle without an on-site cytopathologist.
There were no significant differences in technical success (100 vs. 100%, p = 1.000), the mean number of needle passes (7.0 ± 1.6 vs. 6.8 ± 1.5, p = 0.556), needle malfunction (0 vs. 1.8%, p = 1.000), or complications (1.8 vs. 0%, p = 1.000) between the S+ and S− groups. Both groups exhibited comparable outcomes with respect to cytological diagnostic accuracy (93.0 vs. 91.2%, p = 1.000) and histological diagnostic accuracy (86.0 vs. 87.7%, p = 1.000) for malignancy. The procedure time was significantly shorter in the S− group than in the S+ group (32.4 ± 11.7 vs. 39.7 ± 8.6 min, p < 0.001).
EUS-guided tissue acquisition using a 25-gauge core biopsy needle without a stylet did not decrease the diagnostic yield for malignancy and was associated with a shorter procedure time than that associated with a stylet.
KeywordsEndoscopic ultrasound-guided fine-needle aspiration Endosonography Fine-needle aspiration Fine-needle biopsy Stylet
There is no source of financial support for this study.
Compliance with ethical standards
Min Jae Yang, Jae Chul Hwang, Byung Moo Yoo, Jin Hong Kim, Dakeun Lee, Hyunee Lim, and Young Bae Kim have no conflicts of interest or financial ties to disclose.
- 5.Wani S, Early D, Kunkel J, Leathersich A, Hovis CE, Hollander TG, Kohlmeier C, Zelenka C, Azar R, Edmundowicz S, Collins B, Liu J, Hall M, Mullady D (2012) Diagnostic yield of malignancy during EUS-guided FNA of solid lesions with and without a stylet: a prospective, single blind, randomized, controlled trial. Gastrointest Endosc 76:328–335CrossRefPubMedGoogle Scholar
- 6.Savides TJ (2009) Tricks for improving EUS-FNA accuracy and maximizing cellular yield. Gastrointest Endosc 69:S130-133Google Scholar
- 12.Paik WH, Park Y, Park DH, Hong SM, Lee BU, Choi JH, Lee SS, Seo DW, Lee SK, Kim MH (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 Gastroenterol 49:199–205CrossRefPubMedGoogle Scholar
- 13.Mukai S, Itoi T, Ashida R, Tsuchiya T, Ikeuchi N, Kamada K, Tanaka R, Umeda J, Tonozuka R, Fukutake N, Hoshi K, Moriyasu F, Gotoda T, Irisawa A (2016) Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos). Gastrointest Endosc 83:1210–1217CrossRefPubMedGoogle Scholar
- 16.Rastogi A, Wani S, Gupta N, Singh V, Gaddam S, Reddymasu S, Ulusarac O, Fan F, Romanas M, Dennis KL, Sharma P, Bansal A, Oropeza-Vail M, Olyaee M (2011) A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet. Gastrointest Endosc 74:58–64CrossRefPubMedGoogle Scholar
- 17.Abe Y, Kawakami H, Oba K, Hayashi T, Yasuda I, Mukai T, Isayama H, Ishiwatari H, Doi S, Nakashima M, Yamamoto N, Kuwatani M, Mitsuhashi T, Hasegawa T, Hirose Y, Yamada T, Tanaka M, Sakamoto N (2015) Effect of a stylet on a histological specimen in EUS-guided fine-needle tissue acquisition by using 22-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 82:837–844CrossRefPubMedGoogle Scholar