Puncture of Solid Pancreatic Tumors Guided by Endoscopic Ultrasonography: A Pilot Study Series Comparing Trucut and 19-Gauge and 22-Gauge Aspiration Needles

Background and Study Aims: The aim of this prospective study was to compare endoscopic ultrasonography-guided Trucut needle biopsy (EUS-TNB) with EUS-guided fine-needle aspiration biopsy (EUS-FNAB) using 19- and 22-gauge needles for biopsy from different sites in patients with solid pancreatic cancers.
Patients and Methods: Sixteen consecutive patients with masses in the uncinate process (n = 3), the head (n = 5), or the body and tail (n = 8) of the pancreas underwent both EUS-TNB and EUS-FNAB. The specimens obtained were evaluated by histopathological analysis alone
Results: Tissue specimens were obtained by Trucut needle, and by 19-gauge and 22-gauge aspiration needles in 69 %, 69 %, and 100 % of patients respectively. Sensitivity for malignancy was 69 % for all needles. Tissue sampling by Trucut and by 19-gauge aspiration needle from masses in the uncinate process was impossible. The sensitivity of the Trucut and 19-gauge aspiration needles was 100 % in the 11 patients with successful procedures. If Trucut or19-gauge aspiration needles had been used for body and tail masses, and the 22-gauge aspiration needle for masses in the uncinate process and head, the sensitivity for malignancy would have been 81 %.
Conclusions: EUS-TNB allows reliable tissue sampling for the diagnosis of pancreatic masses, but its use is limited to lesions in the body and tail of the pancreas. EUS-FNAB using a 22-gauge needle may be useful for accurate diagnosis in some patients with masses in the uncinate process or the head of the pancreas.

References

• 1 Rösch T, Braig C, Gain T. et al . Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography: comparison with conventional sonography, computed tomography, and angiography.  Gastroenterology. 1992;  102 188-199
• 2 Yasuda K, Mukai H, Fujimoto S. et al . The diagnosis of pancreatic cancer by endoscopic ultrasonography.  Gastrointest Endosc. 1988;  34 1-8
• 3 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
• 4 Yamao K, Ohashi K, Mizutani S. et al . Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of digestive diseases.  Endoscopy. 1998;  30 A176-A178
• 5 Lai R, Stanley M W, Bardales R. et al . Endoscopic ultrasound-guided pancreatic duct aspiration: diagnostic yield and safety.  Endoscopy. 2002;  34 715-720
• 6 Chang K J, Nguyen P M, Erickson R A. et al . The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma.  Gastrointest Endosc. 1997;  45 387-393
• 7 Bhutani M S, Hawes R H, Baron P L. et al . Endoscopic-ultrasound fine-needle aspiration of malignant pancreatic lesions.  Endoscopy. 1997;  29 854-858
• 8 Das A, Chak A. Endoscopic ultrasonography.  Endoscopy. 2004;  36 17-22
• 9 Giovannini M, Seitz J F, Monges G. et al . Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
• 10 Yeaton P, Sears R J, Ledent T. et al . Discrimination between chronic pancreatitis and pancreatic adenocarcinoma using artificial intelligence-related algorithms based on image cytometry-generated variables.  Cytometry. 1998;  32 309-316
• 11 Binmoeller K F, Thul R, Rathod V. et al . Endoscopic ultrasound-guided, 18-gauge, fine-needle aspiration biopsy of the pancreas using a 2.8-mm channel convex echo endoscope.  Gastrointest Endosc. 1998;  47 121-127
• 12 Voss M, Hammel P, Molas G. et al . Value of endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnosis of solid pancreatic masses.  Gut. 2000;  46 244-249
• 13 Levy M J, Jondal M L, Clain L PNJ. et al . Preliminary experience with an EUS-guided Trucut biopsy needle compared with EUS-guided FNA.  Gastrointest Endosc. 2003;  57 101-106
• 14 Larghi A, Verna E C, Stavropoulos S N. et al . EUS-guided Trucut needle biopsies in patients with solid pancreatic masses: a prospective study.  Gastrointest Endosc. 2004;  59 185-190