Endoscopic ultrasound-guided fine needle core biopsy versus aspiration for gastrointestinal mass lesions: A randomized trial.

Abstract

161 Background: Endoscopic ultrasound (EUS) guided biopsy allows cytologic and/or histologic diagnosis of lesions within or adjacent to the gastrointestinal tract (GIT). However, the amount of tissue obtained with a regular aspirating needle is not always satisfactory. A newly developed Coo Pro-Core 22G needle has been proposed to obtain core tissue and may improve diagnostic yield. This study aimed to compare the performance of two EUS guided biopsy systems, Coo 22G fine needle aspiration (FNA) versus Coo 22G Pro-Core (PC) needle, in the evaluation of mass lesions within or adjacent to the GIT. Methods: 61 consecutive patients, who were referred for EUS guided biopsy of mass lesions within or adjacent to the upper GIT, were randomized to either the use of 22G FNA or 22G PC needle. The procedures were performed by a single experienced EUS-endoscopist. Four needle passes were taken from each lesion and all specimens were prepared as cell-block for histo-cytological analysis. Measured outcomes were diagnostic yield and complication. Results: EUS guided biopsy was performed with 22G FNA needle in 31patients and with 22G PC needle in 30 patients. There were no differences in age, gender, site or size of biopsied lesion between the groups. Diagnostic yield from the PC group was significantly higher than that of the FNA groups (27/30 vs. 22/31, P=0.04). The ability to obtain core-like tissue and provide “histological” detail were also higher in the PC group (16/30 vs. 0/31, P<0.001). Although no patients with FNA biopsy had complications, the first 4 cases of PC needle biopsy had abdominal pain (with 1 proven pancreatitis), requiring overnight admission. No further complications occurred after the number of PC passes was reduced to 2 per lesion. Conclusions: EUS guided biopsy with Pro-Core needles had a substantially higher diagnostic yield than that with FNA needles, with the ability to provide "histological" information in the majority of cases. Initial use of the Pro-Core needle, however, is associated with an increased risk of abdominal pain, which is reduced with fewer passes and more experience.