Combined versus single use 20 G fine-needle biopsy and 25 G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions

Priscilla A. van Riet; Paolo Giorgio Arcidiacono; Mariachiara Petrone; Nam Quoc Nguyen; Masayuki Kitano; Kenneth Chang; Alberto Larghi; Julio Iglesias-Garcia; Marc Giovannini; Schalk van der Merwe; Erwin Santo; Francisco Baldaque-Silva; Juan Carlos Bucobo; Marco J. Bruno; Harry R. Aslanian; Djuna L. Cahen; James Farrell

doi:10.1055/a-0966-8755

Endoscopy, Table of Contents

Endoscopy 2020; 52(01): 37-44
DOI: 10.1055/a-0966-8755

Original article

Combined versus single use 20 G fine-needle biopsy and 25 G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions

Authors

Priscilla A. van Riet

¹Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
Paolo Giorgio Arcidiacono

²Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy
Mariachiara Petrone

²Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy
Nam Quoc Nguyen

³Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
Masayuki Kitano

⁴Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
Kenneth Chang

⁵Comprehensive Digestive Disease Center, University of California, Irvine, California, United States
Alberto Larghi

⁶Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Julio Iglesias-Garcia

⁷Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Marc Giovannini

⁸Institut Paoli-Calmettes, Marseilles, France
Schalk van der Merwe

⁹Department of Hepatology and Biliopancreatic Disease, University Hospital Leuven, Leuven, Belgium
Erwin Santo

¹⁰Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Francisco Baldaque-Silva

¹¹Gastro Center, Karolinska University Hospital, Huddinge, Sweden
Juan Carlos Bucobo

¹²Division of Gastroenterology, Stony Brook University Hospital, New York, New York, United States
Marco J. Bruno

¹Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
Harry R. Aslanian

¹³Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, United States
Djuna L. Cahen‡^*

¹Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
James Farrell‡^*

¹³Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, United States

Abstract

Background Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine-needle aspiration (FNA) and fine-needle biopsy (FNB) consecutively. We explored the yield of combined use of 20 G FNB and 25 G FNA needles in patients with a suspicious solid gastrointestinal lesion.

Methods Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches – FNA followed by FNB, and vice versa.

Results 73 patients were included. There were 39 (53 %) pancreatic lesions, 18 (25 %) submucosal masses, and 16 (22 %) lymph nodes. FNA was used first in 24 patients (33 %) and FNB was used first in 49 (67 %). Generally, FNB was performed after FNA to collect tissue for ancillary testing (75 %), whereas FNA was used after FNB to allow for on-site pathological assessment (76 %). Diagnostic accuracy for malignancy of single needle use increased from 78 % to 92 % with dual sampling (P = 0.002). FNA followed by FNB improved the diagnostic accuracy for malignancy (P = 0.03), whereas FNB followed by FNA did not (P = 0.13).

Conclusion Dual sampling only improved diagnostic accuracy when 25 G FNA was followed by 20 G FNB and not vice versa. As the diagnostic benefit of the 20 G FNB over the 25 G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice.

Full Text

References

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