CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E401-E408
DOI: 10.1055/a-1336-3170
Original article

Use of suction during endoscopic ultrasound-guided fine needle biopsy of solid pancreatic lesions with a Franseen-tip needle: a pilot comparative trial

Pedro Costa-Moreira
1   Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
2   Faculty of Medicine, University of Porto, Portugal
,
Filipe Vilas-Boas
1   Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
2   Faculty of Medicine, University of Porto, Portugal
,
Diana Martins
3   Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
,
Pedro Moutinho-Ribeiro
1   Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
2   Faculty of Medicine, University of Porto, Portugal
,
Susana Lopes
1   Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
2   Faculty of Medicine, University of Porto, Portugal
,
Joanne Lopes
3   Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
,
Helena Barroca
3   Pathology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
,
Guilherme Macedo
1   Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
2   Faculty of Medicine, University of Porto, Portugal
› Author Affiliations
Clinical Trial Registration: Randomized, single-center, prospective crossover study with a single-blinded outcome assessor registered as NCT04164017 at clinicaltrials.gov

Abstract

Background and study aims The utility of suction during endoscopic ultrasound (EUS) fine-needle biopsy (FNB) using Franseen-tip needle remains unclear and has not been evaluated in randomized trials. We designed a randomized crossover trial to compare the diagnostic yield during EUS-FNB using a 22G Franseen-tip needle, with and without standard suction.

Patients and methods Consecutive patients undergoing EUS-guided sampling of solid pancreatic lesions were recruited. A minimum of two passes were performed for each case: one with 20-mL syringe suction (S+) and another without (S–). The order of passes was randomized and the pathologist blinded. The endpoints were the diagnostic yield and the impact of blood contamination in the diagnosis.

Results Fifty consecutive patients were enrolled. The overall diagnostic accuracy was 84 %. A diagnosis of malignancy was obtained in 70 samples: 36 in the S+group and 34 in the S–group. A statistically significant difference was seen in the diagnostic accuracy (S+: 78 % vs. S–: 72 %, P < 0.01) and blood contamination (S+: 68 %; S–: 44 %, P < 0.01). The sensitivity, specificity, negative likelihood ratio and positive likelihood ratio for S+vs. S–samples were 76.6 % vs. 73.9 %, 100 % vs. 100 % and 0.23 vs. 0.26, NA vs NA, respectively. A negative impact of blood contamination in the overall diagnostic yield wasn’t seen, even in samples where suction was used (OR 0.36, P = 0.15)

Conclusions We found a higher diagnostic yield with the use of suction. It was associated with a higher degree of sample blood contamination that did not affect the diagnostic performance.

Supplementary material



Publication History

Received: 10 September 2020

Accepted: 19 November 2020

Article published online:
19 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Conti CB, Cereatti F, Grassia R. Endoscopic ultrasound-guided sampling of solid pancreatic masses: the fine needle aspiration or fine needle biopsy dilemma. Is the best needle yet to come?. World J Gastrointest Endosc 2019; 11: 454-471
  • 2 Muniraj T, Aslanian HR. New developments in endoscopic ultrasound tissue acquisition. Gastrointest Endosc Clin N Am 2017; 27: 585-599
  • 3 Wong NACS. My approach to endoscopic ultrasound-guided fine-needle aspiration biopsy specimens of the pancreas. J Clin Pathol 2020; 73: 297-309
  • 4 Wani S, Muthusamy VR, McGrath CM. et al. AGA White Paper: Optimizing Endoscopic Ultrasound-Guided Tissue Acquisition and Future Directions. Clin Gastroenterol Hepatol 2018; 16: 318-327
  • 5 Costa-Moreira P, Vilas-Boas F, Moutinho-Ribeiro P. et al. Macroscopic on-site evaluation during EUS-fine needle biopsy with combined cyto and histological analysis may overcome the need of rapid on-site evaluation. Endosc Ultrasound 2019; 8: 432-433
  • 6 Mohan BP, Shakhatreh M, Garg R. et al. Comparison of Franseen and fork-tip needles for EUS-guided fine-needle biopsy of solid mass lesions: A systematic review and meta-analysis. Endosc Ultrasound 2019; 8: 382-391
  • 7 Tarantino I, Di Mitri R, Fabbri C. et al. Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. Dig Liver Dis 2014; 46: 523-526
  • 8 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; 77: 745-751
  • 9 Puri R, Vilmann P, Săftoiu A. et al. Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis. Scand J Gastroenterol 2009; 44: 499-504
  • 10 Nakai Y, Isayama H, Chang KJ. et al. Slow Pull Versus Suction in Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Solid Masses. Digestive Diseases and Sciences 2014; 59: 1578-1585
  • 11 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy 2017; 49: 989-1006
  • 12 Nakai Y, Isayama H, Chang KJ. et al. Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses. Dig Dis Sci 2014; 59: 1578-1585
  • 13 Capurso G, Archibugi L, Petrone MC. et al. Slow-pull compared to suction technique for EUS-guided sampling of pancreatic solid lesions: a meta-analysis of randomized controlled trials. Endosc Int Open 2020; 8: E636-E643
  • 14 Pitman MBL, Lester J. The Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology. Switzerland: Springer International Publishing; 2015
  • 15 Bang JY, Hebert-Magee S, Hasan MK. et al. Endoscopic ultrasonography-guided biopsy using a Franseen needle design: Initial assessment. Dig Endosc 2017; 29: 338-346
  • 16 El Chafic AH, Loren D, Siddiqui A. et al. Comparison of FNA and fine-needle biopsy for EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc 2017; 86: 510-515
  • 17 Nayar MK, Paranandi B, Dawwas MF. et al. Comparison of the diagnostic performance of 2 core biopsy needles for EUS-guided tissue acquisition from solid pancreatic lesions. Gastrointest Endosc 2017; 85: 1017-1024
  • 18 Adler DG, Muthusamy VR, Ehrlich DS. et al. A multicenter evaluation of a new EUS core biopsy needle: Experience in 200 patients. Endosc Ultrasound 2019; 8: 99-104
  • 19 El Haddad R, Barret M, Beuvon F. et al. The slow-pull capillary technique increases the quality of endoscopic ultrasound fine needle biopsy samples in solid pancreatic lesions. Eur J Gastroenterol Hepatol 2016; 28: 911-916
  • 20 Di Mitri R, Mocciaro F, Antonini F. et al. Stylet slow-pull vs. standard suction technique for endoscopic ultrasound-guided fine needle biopsy in pancreatic solid lesions using 20 Gauge Procore™ needle: A multicenter randomized trial. Dig Liver Dis 2020; 52: 178-184
  • 21 Yang MJ, Hwang JC, Yoo BM. et al. A prospective randomized trial of EUS-guided tissue acquisition using a 25-gauge core biopsy needle with and without a stylet. Surg Endosc 2018; 32: 3777-3782
  • 22 Iwashita T, Yasuda I, Mukai T. et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study). Gastrointest Endosc 2015; 81: 177-185
  • 23 Oh D, Seo DW, Hong SM. et al. The impact of macroscopic on-site evaluation using filter paper in EUS-guided fine-needle biopsy. Endosc Ultrasound 2019; 8: 342-347
  • 24 Kaneko J, Ishiwatari H, Sasaki K. et al. Macroscopic on-site evaluation of biopsy specimens for accurate pathological diagnosis during EUS-guided fine needle biopsy using 22-G Franseen needle. Endosc Ultrasound 2020; DOI: 10.4103/eus.eus_49_20.
  • 25 Domagk D, Oppong KW, Aabakken L. et al. Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2018; 6: 1448-1460
  • 26 Wallace MB, Kennedy T, Durkalski V. et al. Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy. Gastrointest Endosc 2001; 54: 441-447
  • 27 Jhala NC, Jhala DN, Chhieng DC. et al. Endoscopic ultrasound-guided fine-needle aspiration. A cytopathologist's perspective. Am J Clin Pathol 2003; 120: 351-367
  • 28 Wong N. My approach to endoscopic ultrasound-guided fine-needle aspiration biopsy specimens of the pancreas. J Clin Pathol 2020; 73: 297-309