Abstract
BackgroundEndoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is a standard method for pathological diagnosis of pancreatic solid lesions. The EchoTip ProCore 20G® (PC20), a 20-gauge biopsy needle with a forward-bevel core trap, has been available in Japan since 2015.MethodsWe compared the efficacy of the PC20 with that of the EchoTip ProCore 22G® (PC22) and Acquire 22G® (AC22) in EUS-FNA/B for diagnosing pancreatic cancer. This retrospective study included 191 patients with pancreatic cancer who underwent EUS-FNA/B using the PC20, PC22, or AC22 at our facility from April 2013 to October 2019. We investigated the patients’ clinical characteristics and the diagnostic accuracy and safety of each needle.ResultsA sufficient stroke length of puncture was secured in all patients. The maximum length under EUS was shorter with the AC22 (22.1 ± 2.2 mm) than PC20 (30.6 ± 0.7 mm, p < 0.01) and PC22 (30.3 ± 0.8 mm, p < 0.01). The histological accuracy was 96.4% with the PC20 but only 58.8% with the PC22 (adjusted p (p-adj) < 0.0001) and 75.0% with the AC22 (p-adj = 0.06). The diagnostic accuracy of the combination of histology and cytology was 96.4% with the PC20, while it was 72.1% with the PC22 (p-adj < 0.0001) and 91.7% with the AC22 (p-adj > 0.99). One patient (0.9%) in the PC20 group developed mild pancreatitis, but no adverse events occurred with the other needles.ConclusionsThe PC20 showed better diagnostic capability than the PC22. The diagnostic efficacy was similar between the PC20 and AC22. The high histological accuracy of the PC20 could be advantageous for lesions in which histological assessment is critical.
Highlights
Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is a standard method for pathological diagnosis of pancreatic solid lesions
The maximum diameter of the tumor measured on contrastenhanced computed tomography images was significantly different among the needles (PC20, 37.9 ± 1.2 mm; ProCore 22G® (PC22), 32.9 ± 1.2 mm; Acquire 22G® (AC22), 22.7 ± 2.6 mm; p < 0.0001)
A sufficient stroke length of puncture was secured in all patients, the maximum stroke length for puncture measured on EUS images was shorter with the AC22 (22.1 ± 2.2 mm) (p < 0.01 and p < 0.01 compared with ProCore 20G® (PC20) and PC22, respectively), while there was no significant difference between the PC20 and PC22 (30.6 ± 0.7 and 30.3 ± 0.8 mm, respectively; p > 0.99)
Summary
Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is a standard method for pathological diagnosis of pancreatic solid lesions. Methods: We compared the efficacy of the PC20 with that of the EchoTip ProCore 22G® (PC22) and Acquire 22G® (AC22) in EUS-FNA/B for diagnosing pancreatic cancer. Endoscopic ultrasound-guided fineneedle aspiration/biopsy (EUS-FNA/B) is the standard method for sampling pathological specimens from a pancreatic solid lesion. In the clinical setting, a thicker needle makes the puncture procedure more difficult, during transduodenal puncture in which the steep up-angle of the scope results in less flexibility and greater friction for the needle sheath. This steep up-angle can distort the puncture needle, necessitating additional needles for a subsequent puncture Given these facts, a needle that is flexible but can collect a sufficient volume of specimens for pathological assessment is needed for pancreatic core needle biopsy
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