Endoscopic Ultrasound-guided Specimen Collection and Evaluation Techniques Affect Diagnostic Accuracy

Area of Science:

• Gastroenterology
• Endoscopic Ultrasound (EUS)
• Fine Needle Aspiration (FNA)

Background:

• EUS-FNA diagnostic yield varies with technique, needle gauge, and specimen evaluation methods.
• Optimizing EUS-FNA for pancreatic masses requires understanding the impact of different procedural variables.

Purpose of the Study:

• To directly compare the diagnostic yields of EUS-FNA samples obtained using 22-gauge versus 25-gauge needles, with or without suction.
• To evaluate the influence of needle gauge and suction on specimen adequacy and characteristics.

Main Methods:

• A randomized controlled study of 352 patients with suspected pancreatic masses undergoing EUS-FNA.
• Patients were assigned to 22-gauge or 25-gauge needles, with or without suction.
• Specimens were evaluated via cell block and rapid onsite cytologic evaluation (ROSE); final diagnoses based on histology or 12-month follow-up.

Main Results:

• Overall diagnostic accuracies for cell block, ROSE, and EUS-FNA were 71.9%, 95.5%, and 96.6%, respectively.
• A 22-gauge needle with suction was linked to more passes for diagnosis and increased specimen bloodiness.
• Diagnostic accuracy was lower with 22-gauge needles and suction for transduodenal EUS-FNA compared to other techniques.

Conclusions:

• 22-gauge and 25-gauge needles demonstrated comparable performance for offsite EUS-FNA specimen evaluation in pancreatic masses.
• Suction use during EUS-FNA may necessitate more passes and result in bloodier specimens.
• Individualizing EUS-FNA specimen collection techniques based on evaluation methods is recommended.