scholarly journals An exclusive fine-needle biopsy approach to sampling solid lesions under EUS guidance: a prospective cohort study

2020 ◽  
Vol 8 (5) ◽  
pp. 349-354
Author(s):  
Lindsey M Temnykh ◽  
Mahmoud A Rahal ◽  
Zahra Zia ◽  
Mohammad A Al-Haddad
Keyword(s):  
Adverse Events ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Procedure Time ◽  
Fine Needle ◽  
Significant Difference ◽  
Solid Lesions ◽  
Procedural Outcomes

Abstract Background Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is increasingly utilized to enhance the cytological yield of sampling solid lesions, but its superiority over existing fine-needle aspiration (FNA) platforms has not been clearly demonstrated. The aim of our study was to compare the diagnostic accuracy and procedural outcomes of FNB using a new Franseen-tip needle to that of a traditional FNA in sampling solid lesions under EUS guidance. Methods Consecutive patients with solid lesions referred for EUS-FNB sampling were included. Procedure-related outcomes were collected prospectively including patient demographics, number of passes performed, diagnostic sample adequacy, adverse events, and recovery time. The Acquire needle was used to sample all lesions in the study group. Consecutive EUS-FNA procedures performed to sample solid lesions using the Expect needle were utilized as controls. Results There were 180 patients undergoing EUS-FNB compared to 183 patients undergoing EUS-FNA procedures for solid-lesion sampling. The procedure time was significantly shorter in patients who underwent FNB compared to FNA (mean: 37.4 vs 44.9 minutes, P < 0.001). Significantly fewer passes were performed in the FNB cohort compared to the FNA group (mean: 2.9 vs 3.8, P < 0.001). The cytologic diagnostic yield was significantly higher in the FNB group compared to the FNA group (98.3% vs 90.2%, P = 0.003). No significant difference in the incidence of adverse events was observed between the FNB and FNA groups (1.1% vs 0.5%, P = 0.564). Conclusions An FNB-exclusive approach to sampling solid lesions under EUS guidance is safe and feasible, and may result in fewer overall passes, shorter procedure time, and improved diagnostic adequacy. FNB may replace FNA as the primary sampling modality of choice in all solid lesions.

scholarly journals EUS-guided fine needle biopsy alone vs. EUS-guided fine needle aspiration with rapid on-site evaluation of cytopathology in pancreatic lesions: a multicenter randomized trial

Endoscopy ◽  
2021 ◽  
Author(s):  
Yen-I Chen ◽  
Avijit Chatterjee ◽  
Robert Berger ◽  
Yonca Kanber ◽  
Jonathan M Wyse ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Procedure Time ◽  
Fine Needle ◽  
Site Evaluation ◽  
Sensitivity Specificity ◽  
Solid Lesions

Background and Study Aims: EUS-guided fine needle aspiration (EUS-FNA) is the standard in the diagnosis of pancreatic solid lesions, in particular when combined with rapid on-site evaluation of cytopathology (ROSE). More recently, a fork-tip needle for core biopsy (FNB) has been shown to be associated with excellent diagnostic yield. EUS-FNB alone; however, has not been compared to EUS-FNA+ROSE in a large clinical trial. Our aim is to compare EUS-FNB alone to EUS-FNA+ROSE in solid pancreatic lesions. Patients and Methods: Multicenter non-inferiority RCT involving 7 centers. Solid pancreatic lesions referred for EUS were considered for inclusion. The primary endpoint is diagnostic accuracy. Secondary endpoints include sensitivity/specificity, mean number of needle passes, and cost. Results: 235 patients were randomized: 115 EUS-FNB alone and 120 EUS-FNA+ROSE. Overall, 217 patients had a malignant histology. The diagnostic accuracy for malignancy of EUS-FNB alone was non-inferior to EUS-FNA+ROSE 92.2% (95% CI: 86.6-96.9%) and 93.3% (95% CI: 88.8-97.9%), respectively p=0.72. Diagnostic sensitivity for malignancy was 92.5% (95% CI: 85.7-96.7%) EUS-FNB alone vs. 96.5% (93.0-98.6%) EUS-FNA+ROSE (p=0.46) while specificity was 100% in both. Adequate histology yield was obtained in 87.5% of the EUS-FNB alone samples. Mean number of needle of passes and procedure time favored EUS-FNB alone (2.3±0.6 passes vs. 3.0±1.1 passes p≤0.01 and 19.3±8.0 minutes vs. 22.7±10.8 minutes p <0.01). EUS-FNB alone cost on average 45USD more than EUS-FNA+ROSE. Conclusion: EUS-FNB alone is non-inferior to EUS-FNA+ROSE and is associated with fewer needle passes, shorter procedure time, and excellent histological yield at comparable cost. (clinicaltrials.gov: NCT03435588).

scholarly journals A meta-analysis of endoscopic ultrasound–fine-needle aspiration compared to endoscopic ultrasound–fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment

2017 ◽  
Vol 05 (05) ◽  
pp. E363-E375 ◽  
Author(s):  
Muhammad Khan ◽  
Ian Grimm ◽  
Bilal Ali ◽  
Richard Nollan ◽  
Claudio Tombazzi ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Significant Difference ◽  
Meta Regression ◽  
Optimal Quality

Abstract Background The diagnostic yield of endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is variable, and partly dependent upon rapid onsite evaluation (ROSE) by a cytopathologist. Second generation fine-needle biopsy (FNB) needles are being increasingly used to obtain core histological tissue samples. Aims Studies comparing the diagnostic yield of EUS guided FNA versus FNB have reached conflicting conclusions. We therefore conducted a systematic review and meta-analysis to compare the diagnostic yield of FNA with FNB, and specifically evaluating the diagnostic value of ROSE while comparing the two types of needles. Methods We searched several databases from inception to 10 April 2016 to identify studies comparing diagnostic yield of second generation FNB needles with standard FNA needles. Risk ratios (RR) were calculated for categorical outcomes of interest (diagnostic adequacy, diagnostic accuracy, and optimal quality histological cores obtained). Standard mean difference (SMD) was calculated for continuous variables (number of passes required for diagnosis). These were pooled using random effects model of meta-analysis to account for heterogeneity. Meta-regression was conducted to evaluate the effect of ROSE on various outcomes of interest. Results Fifteen studies with a total of 1024 patients were included in the analysis. We found no significant difference in diagnostic adequacy [RR 0.98 (0.91, 1.06), (I 2 = 51 %)]. Although not statistically significant (P = 0.06), by meta-regression, in the absence of ROSE, FNB showed a relatively better diagnostic adequacy. For solid pancreatic lesions only, there was no difference in diagnostic adequacy [RR 0.96 (0.86, 1.09), (I 2 = 66 %)]. By meta-regression, in the absence of ROSE, FNB was associated with better diagnostic adequacy (P = 0.02). There was no difference in diagnostic accuracy [RR 0.99 (0.95, 1.03), (I 2 = 27 %)] or optimal quality core histological sample procurement [RR 0.97 (0.89, 1.05), (I 2 = 9.6 %)]. However, FNB established diagnosis with fewer passes [SMD 0.93 (0.45, 1.42), (I 2 = 84 %)]. The absence of ROSE was associated with a higher SMD, i. e., in the presence of an onsite pathologist, FNA required relatively fewer passes to establish the diagnosis than in the absence of an onsite pathologist. Conclusions There is no significant difference in the diagnostic yield between FNA and FNB, when FNA is accompanied by ROSE. However, in the absence of ROSE, FNB is associated with a relatively better diagnostic adequacy in solid pancreatic lesions. Also, FNB requires fewer passes to establish the diagnosis.

scholarly journals Su1295 ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION VERSUS FINE NEEDLE BIOPSY IN SOLID LESIONS: A MULTI-CENTER ANALYSIS

2020 ◽  
Vol 91 (6) ◽  
pp. AB317-AB318
Author(s):  
Diogo T. de Moura ◽  
Thomas R. McCarty ◽  
Pichamol Jirapinyo ◽  
Igor B. Ribeiro ◽  
Galileu F. Farias ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Biopsy ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Solid Lesions

scholarly journals Endoscopic ultrasound-guided fine-needle biopsy is superior to fine-needle aspiration in assessing pancreatic neuroendocrine tumors

2019 ◽  
Vol 07 (10) ◽  
pp. E1281-E1287 ◽  
Author(s):  
John S Leeds ◽  
Manu K. Nayar ◽  
Noor L.H. Bekkali ◽  
Colin H. Wilson ◽  
Sarah J. Johnson ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Fine Needle Aspiration ◽  
Needle Biopsy ◽  
Tumor Grade ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Pancreatic Neuroendocrine Tumors ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Solid Lesions

Abstract Background and study aims Pancreatic neuroendocrine tumors (PanNETs) outcomes are dependent upon grading by Ki67. This study compared endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) to fine-needle aspiration (FNA) in assessing PanNETs. Patients and methods All pancreatic histology for PanNET between January 2009 and June 2017 was included if EUS sampling was performed prior to surgical resection. Ki67 and grade from FNA and FNB samples was compared to surgical histology using correlation coefficient and kappa values. Subgroup analysis was performed for purely solid lesions, lesions < 2 cm and FNB needle type. Results One hundred sixity-four patients had PanNET of which 57 underwent surgical resection. Thirty-five lesions underwent FNA and 26 FNB (4 had both) confirming PanNET. 23/ of 35 FNA samples reported Ki67/grading compared to all 26 FNB samples (P = 0.0006). Compared to surgical histology, Ki67 on FNA correlated poorly overall (r = –0.08), in solid lesions (r = –0.102) and lesions < 2 cm (r = –0.149) whereas FNB correlated moderately overall (r = 0.65), in solid lesions (r = 0.64) and lesions < 2 cm (r = 0.61). Tumor grade showed poor agreement (kappa) with FNA overall (0.026), in solid lesions (0.044) and lesions < 2 cm (0.00) whereas FNB showed moderate-good agreement overall (0.474), in solid lesions (0.58) and lesions < 2 cm (0.745). Fork-tip FNB needles Ki67 showed strong correlation with surgical histology (r = 0.788) compared to reverse bevel FNB needles (r = 0.521). Both FNB needles showed moderate agreement with tumor grade. Conclusion FNB samples were significantly more likely than FNA to provide adequate material for Ki67/grading and showed a closer match to surgical histology. FNB needle types require prospective investigation.

Prospective comparative study of endoscopic ultrasonography-guided fine-needle biopsy and unroofing biopsy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 38-38 ◽  
Author(s):  
Sung Kwan Shin ◽  
Jun Chul Park ◽  
Eun Hye Kim ◽  
Sang Kil Lee ◽  
Yong Chan Lee
Keyword(s):  
Comparative Study ◽  
Endoscopic Ultrasonography ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Histological Diagnosis ◽  
Fine Needle ◽  
Significant Difference ◽  
Prospective Comparative Study ◽  
The Mean

38 Background: Adequate tissue acquisition is important in making treatment decisions for patients with upper gastrointestinal subepithelial tumors (SETs). This study aimed to compare the outcomes of endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) with those of the unroofing biopsy technique. Methods: This study was a single-center, prospective comparative study conducted at Severance Hospital, Yonsei University College of Medicine. A total of 39 patients with SETs ≥15 mm were enrolled between January 2016 and August 2017. Results: Of the 39 patients, 28 underwent biopsy with both techniques (4 underwent only unroofing and 7 underwent only EUS-FNB). The mean tumor size was 21.0 mm (median, 19.0 mm; 15.0–45.0 mm). Histological diagnosis was made with EUS-FNB in 64.3% and with unroofing biopsy in 78.6% (p = 0.344), and immunohistochemical diagnosis was made with EUS-FNB in 46.4% and unroofing biopsy in 67.9% (p = 0.180). In the subgroup analysis (28 patients), there was no significant difference in diagnostic yield between the 2 methods. The mean procedural time with EUS-FNB was shorter than that with unroofing biopsy (p < 0.001). The larger SET (≥ 20 mm) (p = 0.035) and satisfaction of procedure (p = 0.019) were positively associated with successful histological diagnosis by EUS-FNB. No complications were reported with both methods. Conclusions: There was no significant difference in the histological diagnostic yield for SETs between the EUS-FNB and unroofing biopsy techniques. Further study is needed to confirm the efficacy of EUS-FNB and unroofing biopsy in a larger study population. Clinical trial information: NCT02646241.

scholarly journals Macroscopic on-site evaluation (MOSE) of specimens from solid lesions acquired during EUS-FNB: multicenter study and comparison between needle gauges

2021 ◽  
Vol 09 (06) ◽  
pp. E901-E906
Author(s):  
Benedetto Mangiavillano ◽  
Leonardo Frazzoni ◽  
Thomas Togliani ◽  
Carlo Fabbri ◽  
Ilaria Tarantino ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Median Number ◽  
Needle Aspiration ◽  
Multivariable Logistic Regression Analysis ◽  
Fine Needle ◽  
Large Size ◽  
Site Evaluation ◽  
Needle Diameter ◽  
Solid Lesions

Abstract Background and study aims The standard method for obtaining samples during endoscopic ultrasonography (EUS) is fine-needle aspiration (FNA), the accuracy of which can be affected by the presence of a cytopathologist in endoscopy room (rapid on-site evaluation [ROSE]). With the introduction of fine-needle biopsy (FNB), macroscopic on-site evaluation (MOSE) of a acquired specimen has been proposed. Only a few studies have evaluated the role of MOSE and in all except one, a 19G needle was used. Our primary aim was to evaluate the diagnostic yield and accuracy of MOSE with different needle sizes and the secondary aim was to identify factors influencing the yield of MOSE. Patients and methods Data from patients who underwent EUS-FNB for solid lesions, with MOSE evaluation of the specimen, were collected in six endoscopic referral centers. Results A total of 378 patients (145 F and 233 M) were enrolled. Needles sizes used during the procedures were 20G (42 %), 22G (45 %), and 25G (13 %). The median number of needle passes was two (IQR 2–3). The overall diagnostic yield of MOSE was of 90 % (confidence interval [CI] 86 %–92 %). On multivariable logistic regression analysis, variables independently associated with the diagnostic yield of MOSE were a larger needle diameter (20G vs. 25G, OR 11.64, 95 %CI 3.5–38.71; 22G vs. 25G, OR 6.20, 95 %CI 2.41–15.90) and three of more needle passes (OR 3.39, 95 %CI 1.38–8.31). Conclusions MOSE showed high diagnostic yield and accuracy. Its yield was further increased if performed with a large size FNB needles and more than two passes.

scholarly journals Clinical Impact of EUS-Guided Fine Needle Biopsy Using a Novel Franseen Needle for Histological Assessment of Pancreatic Diseases

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Takuya Ishikawa ◽  
Hiroki Kawashima ◽  
Eizaburo Ohno ◽  
Hiroyuki Tanaka ◽  
Daisuke Sakai ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diagnostic Accuracy ◽  
Needle Biopsy ◽  
Fine Needle Biopsy ◽  
Pancreatic Diseases ◽  
Fine Needle ◽  
Histological Assessment ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background and Aims. Several studies have shown the benefits of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a Franseen needle for histological assessment. However, studies focusing on pancreatic diseases are limited and the safety of this method has not been well assessed. We aimed to assess the current status and issues of EUS-FNB in the diagnosis of pancreatic diseases. Materials and Methods. We retrospectively reviewed 87 consecutive EUS-FNB specimens using either a 22-gauge Franseen needle (Group A, N = 51) or a conventional 22-gauge fine-needle aspiration needle (Group B, N = 36) for pancreatic diseases, and the diagnostic accuracy and safety were compared. Final diagnoses were obtained based on surgical pathology or a minimum six-month clinical follow-up. Results. Although the diagnostic accuracy for malignancy was 96.1% in Group A versus 88.9% in Group B, with no statistically significant difference (P = 0.19), the median sample area was significantly larger in Group A (4.07 versus 1.31mm2, P < 0.0001). There were no differences between the two needles in the locations from which the specimens were obtained. Adverse events occurred in one case (2%) in Group A (mild pancreatitis) and none in Group B with no statistical significance (P = 0.586). Although there was no case of bleeding defined as adverse events, 2 cases in Group A showed active bleeding during the procedure with increase in the echo-free space, which required CT scanning to rule out extravasation. Eventually, the bleeding stopped spontaneously. Conclusions. Given its guaranteed ability to obtain core specimens and comparable safety, and although the risk of bleeding should be kept in mind, EUS-FNB using a Franseen needle is likely to become a standard procedure for obtaining pancreatic tissue in the near future.

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