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Blinded prospective comparison of the performance of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of the pancreas and peri-pancreatic lesions.

Abstract：

BACKGROUND:Both 22- and 25-gauge needles are used for endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of lesions, yet limited data exist on whether either offers an advantage over the other in terms of specimen cellularity and quality. AIM:The aim of this study was to compare sample quality for 22- and 25-gauge needles in EUS-guided FNA of pancreatic and peri-pancreatic lesions. METHODS:Between October 2005 and June 2006, 12 patients with pancreatic or peripancreatic lesions underwent EUS-guided FNA with both 22- and 25-gauge Wilson-Cook Echotip needles. All procedures were performed with an Olympus linear echoendoscope by the same endoscopist to eliminate operator-dependent variability. Needle order was selected randomly, and two passes were made with each needle, consisting of ten uniform to-and-fro movements on each pass with 10-ml syringe suction. The specimens were immediately stained and independently reviewed by two cytopathologists, who were blinded to the needle used. Cellularity was graded as 0 to 6, with 6 being most cellular. RESULTS:No statistically significant difference in cellularity was detected between the two needle size groups by cytologist 1 (mean difference, 0.04; 95% confidence interval [CI], -1.22 to 1.30; p = 0.94) or by cytologist 2 (mean difference, 0.2; 95% CI, -1.23 to 1.65; p = 0.76). When the data from both cytologists were combined, no significant difference in cellularity was detected between the two needle sizes (mean difference, 0.125; 95% CI, -1.22 to 1.47; p = 0.84). No significant difference in cellularity was detected between cytologists 1 and 2 (mean difference, 0.17; 95% CI, -0.15 to 0.48; p = 0.27). When the order in which needles were used was compared, no significant difference in cellularity was detected (p = 0.75). Three mechanical failures occurred with 25-gauge needles, but none occurred with 22-gauge needles. The visibility of the needles on EUS did not differ. Cytologic diagnoses were achieved in all cases: seven pancreatic adenocarcinomas, one pancreatic giant cell carcinoma, one pancreatic neuroendocrine tumor, one metastatic non-small cell carcinoma, one metastatic colon carcinoma, and one pancreatitis. There were no procedure-related complications. CONCLUSIONS:Both FNA needles provided accurate diagnoses in all patients. There was no significant difference between the 22- and 25-gauge needle groups in the independent interpretation of two cytopathologists with respect to cellular yield and ability to render a diagnosis.

journal_name

Dig Dis Sci

journal_title

Digestive diseases and sciences

authors

Lee JH,Stewart J,Ross WA,Anandasabapathy S,Xiao L,Staerkel G

doi

10.1007/s10620-009-0906-1

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

2274-81

issue

eissn

0163-2116

issn

1573-2568

journal_volume

pub_type

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Blinded prospective comparison of the performance of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of the pancreas and peri-pancreatic lesions.