Mo1321 PROSPECTIVE COMPARISON STUDY OF FRANSEEN NEEDLE AND STANDARD NEEDLE USE FOR PANCREATIC LESIONS UNDER EUS-GUIDANCE

Abstract

To ensure diagnosis with EUS-FNA, various efforts have been reported, such as on-site evaluation and technical methods including slow pull and wet suction technique. On the other hand, obtaining sufficient tissue is one of the most important points to facilitate the assessment and subtyping of various neoplasms and for further immunohistochemical investigations of tumor type. In addition, if treatment such as chemotherapy according to the genotype of tumors improves, sufficient tissue may be needed to treat patients using an individualized approach according to the histological results. Recently, an FNA needle with Franseen geometry has become available. However, there are no reports of prospective evaluations of the Franseen needle and of comparison studies with the standard needle. The aim of this comparative prospective study was to evaluate the histological diagnostic yield of the Franseen needle and the standard needle using tissue obtained by a single pass of each for same lesion. Only tissue obtained by the first pass using the Franseen needle (22G) was used. As a comparison group, only tissue obtained by the second pass using the standard needle (22G) was used for same lesion. Evaluation of histological diagnostic yield was based on tissue obtained by each single pass with no additional passes. A total of 56 patients (median age, 72.5 years; age range, 58-84 years; 30 men, 26 women) were prospectively enrolled. EUS-FNA was successfully performed using first the Franseen needle and then the standard needle (technical success 100%). The median size of the target lesions was 20 mm. The location of the puncture site was the head (n=27), body (n=19), and tail (n=10) of the pancreas. The final diagnosis was: malignant disease n=52 (92.9%), including adenocarcinoma n=47, metastatic tumor n=2, neuroendocrine carcinoma n=1, and malignant lymphoma n=2; and benign disease n=4 (7.1), including chronic pancreatitis n=1, autoimmune pancreatitis n=2, and neuroendocrine tumor n=1. Among benign diseases, the final diagnosis was based on clinical follow-up without progressive disease and surgical resection (neuroendocrine tumor n=1). The rate of adequate tissue obtained by the Franseen needle was 89.3%. On the other hand, the rate of adequate tissue obtained by the standard needle was 62.5%. Thus, the rate of adequate tissue was significantly higher for the Franseen needle than for the standard needle (P<0.05). The sensitivity and accuracy of the Franseen needle were 80.7%, and 84.6%, respectively. On the other hand, thats of the standard needle were 59.6%, and 63.5%, respectively. Compared with the standard needle, the diagnostic yield and rate of adequate tissue with the Franseen needle were good. The Franseen needle has a better rate of obtaining adequate tissue and a higher diagnostic accuracy than the standard needle.