A prospective comparison of endoscopic ultrasound-guided fine needle aspiration results obtained in the same lesion, with and without the needle stylet

Background and study aims: The effectiveness of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with (S+) and without (S–) a stylet has never been compared. We prospectively compared the yield for malignancy and sample quality of S+ and S– EUS-FNA.

Patients and methods: S+ or S– EUS-FNA was performed on consecutive solid lesions, with a 22-gauge needle, with systematic assignment of S+ or S– passes in a 1 : 2 ratio. Slides were read by a single, blinded cytologist and were rated for bloodiness, adequacy, and presence of malignancy. The yield for malignancy was compared only in lesions in which equal numbers of S+ and S– passes were performed.

Results: A total of 309 passes (mean 2.3 passes/lesion, range 1 – 6, 82 % adequate, 38 % S+, 62 % S–) were performed on 135 lesions (63 % malignant, 42 % nodes, 58 % masses [79 % pancreatic]) in 111 patients (mean age 62.9 years, range 30 – 86). In 46 lesions where an equal number (53 S+ and 53 S–) of passes was performed, there was no difference in the proportion of cases in which S+ FNA was “equal to or better than” S– FNA ([S+] 89 % vs. [S–] 87 %; P > 0.05). The results of the two methods agreed in 80 % cases (kappa 0.60). The sensitivities for malignancy were: S+ 87 % vs. S– 83 %, P > 0.05. Specificities were 100 %. Sample adequacy was significantly lower in S+ passes (75 % vs. 87 %, P = 0.013), and sample bloodiness was significantly higher (75 % vs. 52 %, P < 0.0001).

Conclusions: Use of the stylet with EUS-FNA does not increase the yield for malignancy and is associated with poorer sample quality. The value of the stylet for EUS-FNA is questionable and requires further investigation.

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