Prospective evaluation of the optimal number of 25‐gauge needle passes for endoscopic ultrasound‐guided fine‐needle aspiration biopsy of solid pancreatic lesions in the absence of an onsite cytopathologist

• DOI: 10.1111/j.1443-1661.2012.01311.x
• Publication Date: 2012-04-10T07:28:19Z
• Authors: Rei Suzuki; Atsushi Irisawa; Manoop S. Bhutani; Takuto Hikichi; Tadayuki Takagi; Ai Sato; Masaki Sato; Tsunehiko Ikeda; Ko Watanabe; Jun Nakamura; Kazuhiro Tasaki; Katsutoshi Obara; Hiromasa Ohira
• Keywords: Male; Reproducibility of Results; Equipment Design; 3. Good health; Diagnosis, Differential; Pancreatic Neoplasms; 03 medical and health sciences; 0302 clinical medicine; Needles; Humans; Female; Prospective Studies; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Pancreas; Aged

Introduction: A prior study with 22‐gauge needles recommended more than seven needle passes for endoscopic ultrasound‐guided fine‐needle aspiration biopsy (EUS‐FNA) of solid pancreatic lesions (SPL) without onsite cytopathology for optimal acquisition of cytopathological diagnosis. The feasibility of this recommendation should be re‐evaluated considering the later development and popularity of 25‐gauge EUS‐FNA needles. We aimed to determine the optimal number of needle passes for cytopathological specimen acquisition with 25‐gauge needles for EUS‐FNA of SPL.Methods: A preliminary prospective study of 22 patients with an onsite cytopathology technician showed a sensitivity of 93.3% and a specificity of 100% with four needle passes that was not statistically different from five needle passes. Based on our preliminary study, we fixed the number of needle passes to four (Group A). As a control group, we carried out sampling in consecutive patients using 25‐gauge needles with an onsite cytopathologist (Group B). Sampling rate, diagnostic value and complications were evaluated.Results: We enrolled 20 patients in each group. Sampling rate was higher in Group B (20/20, 100%) than in Group A (19/20, 95%), but there was no statistical difference between them (P‐value = 0.31). In Group A, sensitivity, specificity and accuracy were 100% among 19. In Group B, sensitivity was 94.1%, specificity 100%, accuracy 95%. There were also no statistical differences between the groups. No complications were seen.Conclusion: Our study suggests that four needle passes using a 25‐gauge needle may be sufficient for EUS‐FNA of SPL where onsite cytology is not available.