A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses
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Published on: May 23, 2015
Jun Kyu Lee1, Jong Hak Choi, Kwang Hyuck Lee
1Department of Internal Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, Republic of Korea.
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.).
