Endoscopy 2016; 48(04): 339-349
DOI: 10.1055/s-0034-1393354
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition

Ji Young Bang
1   Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, United States
Robert Hawes
2   Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, United States
Shyam Varadarajulu
2   Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, United States
› Author Affiliations
Further Information

Publication History

submitted 01 December 2014

accepted after revision 08 September 2015

Publication Date:
12 November 2015 (online)

Background and study aims: To overcome the limitations associated with cytology, a uniquely designed needle (ProCore) was introduced in an effort to obtain a core of tissue under endoscopic ultrasound (EUS) guidance. However, studies comparing the sample quality between ProCore and standard-design fine-needle aspiration (FNA) needles have yielded varying results. A systematic review and meta-analysis was therefore conducted to compare the performance of the ProCore and standard FNA needles when performing EUS-guided tissue acquisition.

Patients and methods: MEDLINE and EMBASE were searched to identify all published manuscripts that compared the ProCore needle with standard FNA needles. Noncomparative and technical feasibility studies were excluded. The main outcome measures were diagnostic adequacy, diagnostic accuracy, acquisition of histological core tissue, and mean number of passes required to achieve a diagnosis when sampling solid lesions.

Results: Nine studies (total 576 patients) met the inclusion criteria. There was no significant difference in diagnostic adequacy (75.2 % vs. 89.0 %, odds ratio [OR] 0.39, P = 0.23), diagnostic accuracy (85.8 % vs. 86.2 %, OR 0.88, P = 0.53) or rate of histological core specimen acquisition (77.7 % vs. 76.5 %, OR 0.94, P = 0.85) between the ProCore and standard FNA needles, respectively. The mean number of passes required for diagnosis, however, was significantly lower when using the ProCore needle (standardized mean difference – 1.2, P < 0.001).

Conclusions: Current data do not demonstrate a significant difference between the ProCore and standard FNA needles for sample adequacy, diagnostic accuracy or acquisition of a core specimen. However, the ProCore needle establishes the diagnosis with fewer passes.

  • References

  • 1 Eltoum IA, Alston EA, Roberson J. Trends in pancreatic pathology practice before and after implementation of endoscopic ultrasound-guided fine-needle aspiration. Arch Pathol Lab Med 2012; 136: 447-453
  • 2 Levy MJ, Wiersema MJ. EUS-guided Trucut biopsy. Gastrointest Endosc 2005; 62: 417-426
  • 3 Gleeson FC, Kipp BR, Caudill JL et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut 2010; 59: 586-594
  • 4 Wakatsuki T, Irisawa A, Terashima M et al. ATP assay-guided chemosensitivity testing for gemcitabine with biopsy specimens obtained from unresectable pancreatic cancer using endoscopic ultrasonography-guided fine-needle aspiration. Int J Clin Oncol 2011; 16: 387-394
  • 5 Brais RJ, Davies SE, O’Donovan M et al. Direct histological processing of EUS biopsies enables rapid molecular biomarker analysis for interventional pancreatic cancer trials. Pancreatology 2012; 12: 8-15
  • 6 Wiersema MJ, Levy MJ, Harewood GC et al. Initial experience with EUS-guided trucut needle biopsies of perigastric organs. Gastrointest Endosc 2002; 56: 275-278
  • 7 Wittmann J, Kocjan G, Sgouros SN et al. Endoscopic ultrasound-guided tissue sampling by combined fine needle aspiration and trucut needle biopsy: a prospective study. Cytopathology 2006; 17: 27-33
  • 8 Larghi A, Verna EC, Stavropoulos SN et al. EUS-guided trucut needle biopsies in patients with solid pancreatic masses: a prospective study. Gastrointest Endosc 2004; 59: 185-190
  • 9 Iglesias-Garcia J, Poley JW, Larghi A et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
  • 10 Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol 2007; 36: 666-676
  • 11 Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17: 1-12
  • 12 Bang JY, Hebert-Magee S, Trevino J et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
  • 13 Kim GH, Cho YK, Kim EY et al. Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand J Gastroenterol 2014; 49: 347-354
  • 14 Lee YN, Moon JH, Kim HK et al. Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study. Endoscopy 2014; 46: 1056-1062
  • 15 Vanbiervliet G, Napoléon B, Paul MCS et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46: 1063-1070
  • 16 Hucl T, Wee E, Anuradha S et al. Feasibility and efficiency of a new 22G core needle: a prospective comparison study. Endoscopy 2013; 45: 792-798
  • 17 Strand DS, Jeffus SK, Sauer BG et al. EUS-guided 22-gauge fine-needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms. Diagn Cytopathol 2014; 42: 751-758
  • 18 Mavrogenis G, Weynand B, Sibille A et al. 25-gauge histology needle versus 22-gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathy. Endosc Int Open 2015; 3: E63-E68
  • 19 Witt BL, Adler DG, Hilden K et al. A comparative needle study: EUS-FNA procedures using the HD ProCore and EchoTip 22-gauge needle types. Diagn Cytopathol 2013; 41: 1069-1074
  • 20 Berzosa M, Villa N, El-Serag HB et al. Comparison of endoscopic ultrasound guided 22-gauge core needle with standard 25-gauge fine-needle aspiration for diagnosing solid pancreatic lesions. Endosc Ultrasound 2015; 4: 28-33
  • 21 Chambers D, Rodgers M, Woolacott N. Not only randomized controlled trials, but also case series should be considered in systematic reviews of rapidly developing technologies. J Clin Epidemiol 2009; 62: 1253-1260
  • 22 Jhala N, Jhala D. Definitions in tissue acquisition: core biopsy, cell block, and beyond. Gastrointest Endosc Clin N Am 2014; 24: 19-27
  • 23 Panic N, Larghi A. Techniques for endoscopic ultrasound-guided fine-needle biopsy. Gastrointest Endosc Clin N Am 2014; 24: 83-107
  • 24 Sakamoto H, Kitano M, Komaki T et al. Prospective comparative study of the EUS-guided 25-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol 2009; 24: 384-390
  • 25 Bang JY, Magee SH, Ramesh J et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-450
  • 26 Hébert-Magee S, Bae S, Varadarajulu S et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology 2013; 24: 159-171
  • 27 Hébert-Magee S. How can an endosonographer assess for diagnostic sufficiency and options for handling the endoscopic ultrasound-guided fine-needle aspiration specimen and ancillary studies. Gastrointest Endosc Clin N Am 2014; 24: 29-56