Increasing Number of Passes Beyond 4 Does Not Increase Sensitivity of Detection of Pancreatic Malignancy by Endoscopic Ultrasound–Guided Fine-Needle Aspiration

Abstract Background and study aim Standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedures involve use of no-suction or suction aspiration techniques. A new aspiration method, the stylet slow-pull technique, involves slow withdrawal of the needle stylet to create minimum negative pressure. The aim of this study was to compare the sensitivity of EUS-FNA using stylet slow-pull or suction techniques for malignant solid pancreatic lesions using a standard 22-gauge needle. Patients and methods Consecutive patients presenting for EUS-FNA of pancreatic mass lesions were randomized to the stylet slow-pull or suction techniques using a 22-gauge needle. Both techniques were standardized for each pass until an adequate specimen was obtained, as determined by rapid on-site cytology examination. Patients were crossed over to the alternative technique after four nondiagnostic passes. Results Of 147 patients screened, 121 (mean age 64 ± 13.8 years) met inclusion criteria and were randomized to the stylet slow-pull technique (n = 61) or the suction technique (n = 60). Technical success rates were 96.7 % and 98.3 % in the slow-pull and suction groups, respectively (P > 0.99). The sensitivity for malignancy of EUS-FNA was 82 % in the slow-pull group and 69 % in the suction group (P = 0.10). The first-pass diagnostic rate (42.6 % vs. 38.3 %; P = 0.71), acquisition of core tissue (60.6 % vs. 46.7 %; P = 0.14), and the median (range) number of passes to diagnosis (2 1 2 3 vs. 1 1 2; P = 0.71) were similar in the slow-pull and suction groups, respectively. Conclusions The stylet slow-pull and suction techniques both offered high and comparable diagnostic sensitivity with a mean of 2 passes required for diagnosis of solid pancreatic lesions. The endosonographer may choose either technique during FNA.

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Randomized controlled trial of comparison of the adequacy, and diagnostic yield of endoscopic ultrasound guided fine needle aspiration with and without a stylet in Indian patients: A prospective single blind study

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.150662 ◽

2014 ◽

Vol 05 (04) ◽

pp. 149-153 ◽

Cited By ~ 4

Author(s):

Sandeep Nijhawan ◽

Bir Singh ◽

Amritesh Kumar ◽

Dilip Ramrakhiani ◽

Amit Mathur ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Diagnostic Yield ◽

Controlled Trial ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle ◽

Tertiary Center ◽

Significant Difference ◽

Number Of Passes

Abstract Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is done using EUS-FNA needle with an internal stylet by most of the endosonographers. There is no data to suggest that it improves the quality of cytology specimen, and it is tedious and time-consuming. Aim: To compare EUS-FNA specimens obtained with stylet and without stylet for adequacy of the specimen, amount of blood on the slide, number of passes and diagnostic yield. Materials and Methods: Patients undergoing EUS-FNA of solid lesions by one experienced endosonographer at an Indian tertiary center from October 2013 to July 2014 were included. Totally, 115 consecutive patients with 128 lesions were randomized to undergo EUS-FNA with or without stylet. Cytology slides were evaluated by a single pathologist blinded to FNA technique. Results: EUS-FNA was done with stylet in 66 lesions (Group 1) and without stylet in 62 lesions (Group 2). Site of lesion was lymph node in 67 (52.3%), pancreas in 43 (33.6%), liver in 8 (6.2%), gastrointestinal subepithelial lesion in 4 (3.1%) and others in 6 (4.9%). The average size of the lesion was 23.7 ± 14.8. When outcomes of two groups were compared, there was no statistically significant difference in adequacy of smears (P = 1.00), amount of blood on slides (P = 0.92), number of passes (P = 0.49) and diagnostic yield (P = 0.86). Conclusions: There was no significant difference in adequacy of the specimen, amount of blood on the slide, number of passes and diagnostic yield between with and without a stylet groups. The use of a stylet does not confer any advantage during EUS-FNA.

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