Comparison of EUS-FNA with 25gage, 22gage, and 19gage needle

Background: After Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for Gastroenterological diseases was firstly reported in 1992, EUS-FNA has become popular in the clinical fields. It has been reported that the usefulness for diagnosing and treatment of gastrointestinal and bilio-pancreatic diseases. There are lots of instruments for EUS-FNA that have been developed in order to improve the accuracy of diagnosis. At the moment needle sizes of EUS-FNA commonly used are 19G, 22G and 25G. As increasing the size of needle, the larger tissue might be obtained, however it becomes rather difficult to puncture the targets for EUS-FNA. There are several report about 19G, true cut needle and 22G needle, and as conclusion, there is not significant difference between 19G and 22G. On the other hand, 25G needle has started to be employed frequently. Because diagnostic adequacy of 25G needle for pulmonary diseases showed in 92% and with a definitive diagnosis in 88% of cases. And a smaller needle size decreases potential of complications such as bleeding etc. However 22G needle is commonly employed in the clinical fields.

Aims: In order to investigate the differences between 25G, 22G, and 19G needle for EUS-FNA, we reviewed patients records who were performed EUS-FNA with these needles in our hospital.

Materials and Methods: From Nov. 2008 to Apr. 2010, we had performed EUS-FNA for 85 cases in our hospital. They consisted of SMT of GI: 33, pancreatic diseases: 41, mediastinal diseases: 4, Lymph nods: 4 and others: 3. These procedures were performed with needles: NA-200H (Olympus Co.), Echo-tip 25G and 22G (Wilson Cook Inc.), scope: GF-UCT240, GF-UC2000P, and GF-Y0007-UCT (Olympus Co.). All cases were punctured with different size needles at one session. We have investigated and compared retrospectively with the sampling rate, the diagnostic accuracy, and the complications of each needles.

Result: Using 25G, it is more easy to puncture the target with difficulty such as small size, SMT, pancreas head lesion etc., compared to other needles. Using 19G, we can obtain larger sample, if succeed, however it is difficult to puncture small lesions and pancreas head lesions etc.

1, The sampling rate was 100% (85/85).

2, The diagnostic accuracy was 19G: 71.9% (23/32), 22G: 75.9% (63/83), 25G: 71.2% (42/59).

3, The diagnostic accuracy of each disease: SMT; 19G: 66.7% (12/18), 22G: 81.8% (27/33), 25G: 25; 76.5% (13/17). Pancreatic cancer; 22G: 72.0% (18/25), 25G: 80.0% (20/25). Chronic Pancreatitis; 19G: 50.0% (2/4), 22G: 57.1% (4/7), 25G; 80.0% (4/5). Pancreatic tumor (excluding cancer); 19G: 100% (2/2), 22G: 83.3% (5/6), 25G; 50.0% (3/6). Mediastinal diseases and Lymph-nods; 19G: 66.7% (4/6), 22G: 75.0% (6/8), 25G; 100% (3/3).

In the cases of SMT, the accuracy rate with 19G needle tends to be lower than other in the cases of Pancreatic tumor, and also tends to be higher than other size needles. In the cases of chronic pancreatitis, mediastinal diseases and lymph-nods, the accuracy rate with 25G needle tends to be higher than other size needle's. In the cases of Pancreas cancer and other diseases, there is no significant difference between each needle size.

4, Its complications were 0% (0/85).

Conclusion: We concluded that we are now approaching the new era, in which we have to select appropriate needle size for each lesion.