A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses

Jun Kyu Lee, Jong Hak Choi, Kwang Hyuck Lee, Kwang Min Kim, Jae Uk Shin, Jong Kyun Lee, Kyu Taek Lee, Kee Taek Jang

Research output: Contribution to journalArticlepeer-review

117 Scopus citations

Abstract

Background: There is no standardization of the use of suction during puncturing of a target in pancreatic EUS-guided FNA (EUS-FNA). It is also debatable whether expressing aspirates from the needle by the traditional method of reinserting the stylet is more effective than by air flushing, which is easier and safer. Objective: To optimize sampling techniques in pancreatic EUS-FNA. Design: Prospective, comparative trial. Setting: Tertiary-care referral center. Patients: Eighty-one consecutive patients with solid pancreatic masses. Intervention: Four punctures were performed for each mass in random order by a 2 × 2 factorial design. Sample quality and diagnostic yield were compared between samples with suction (S+) versus no suction (S-) and expressed by reinserting the stylet (RS) versus air flushing (AF). Main Outcome Measurements: Sample quality by the number of diagnostic samples, cellularity, bloodiness, and air-drying artifact; diagnostic yield by accuracy, sensitivity, and specificity. Results: The number of diagnostic samples (72.8% vs 58.6%; P =.001), cellularity (odds ratio [OR] 2.12; 95% confidence interval [CI], 1.37-3.30; P <.001), bloodiness (OR 1.46; CI, 1.28-1.68; P <.001), accuracy (85.2% vs 75.9%; P =.004), and sensitivity (82.4% vs 72.1%; P =.005) were higher in S+ than in S-. Bloodiness was lower in AF than in RS (OR 1.16; CI, 1.03-1.30; P =.017). Limitations: Single-center trial, 2 kinds of needle gauges, and no immediate cytopathology evaluation. Conclusion: Puncturing with suction and expressing by air flushing may be used preferentially in pancreatic EUS-FNA because they were more effective and convenient techniques. (Clinical trial registration number: NCT01354795.)

Original languageEnglish
Pages (from-to)745-751
Number of pages7
JournalGastrointestinal Endoscopy
Volume77
Issue number5
DOIs
StatePublished - May 2013

Keywords

  • AF
  • EUS-FNA
  • EUS-guided FNA
  • RS
  • S+
  • S-
  • samples expressed by air flushing
  • samples expressed by reinserting the stylet
  • samples with no suction during puncturing
  • samples with suction during puncturing

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