Multiple fine-needle biopsies using a coaxial technique: efficacy and a comparison of three methods

Compare the success of three coaxial fine-needle biopsy techniques in obtaining multiple cytologic specimens of high quality.

For each of three different biopsy needle and technique combinations (aspiration: 22-gauge Chiba; capillary: 22-gauge Chiba; 22-gauge Autovac aspiration biopsy gun), 30 sites (15 liver, 15 kidney) were selected for coaxial fine-needle biopsy in cadaveric liver and kidneys. For each coaxial technique, three sequential biopsies were performed through an 18-gauge coaxial needle at each of multiple sites. The quality of the resultant 270 specimens was graded by a blinded cytopathologist using a previously published grading scheme.

Using the coaxial technique, there was no significant dropoff in the cytologic specimen quality among the first, second, and third biopsies at a specific site, regardless of the order of the techniques/needles used. This was true for organs, the overall data, and for the individual five grading criteria. There was, however, a significant difference among the biopsy techniques themselves. Though there was no difference in the quality of cytopathologic specimen obtained with the Autovac aspiration gun and the aspiration technique with a 22-gauge Chiba needle, both were statistically better than the nonaspiration, capillary technique utilizing a 22-gauge needle (p = 0.0001).

The use of a coaxial technique with a fine-needle, 22-gauge biopsy offers unique advantages in obtaining a nearly unlimited amount of high-quality material for cytopathologic analysis. In this study, no dropoff was found in specimen quality with subsequent biopsies.