Su1309 COMPARISON OF TWO SPECIALIZED HISTOLOGY NEEDLES FOR ENDOSCOPIC ULTRASOUND GUIDED LIVER BIOPSY

Abstract

EUS-guided liver biopsy (EUS-LB) is increasingly becoming a common procedure, with a favorable safety profile and relative ease of tissue acquisition for histologic purposes. This growth in procedure volume has been driven, in part, by the release of newer fine needle biopsy (FNB) needles that each purport to be superior for tissue acquisition. However, to date, there have been no in vivo head-to-head study comparing the performance of these newer generation FNB needles for liver biopsy. In this study, we evaluated the efficacy of two second-generation 19G FNB (Franseen and fork-tip) needles in EUS-LB. This was a prospective, randomized crossover study. We performed EUS-LB with one pass and one actuation method using two 19G FNB needles in 22 consecutive patients between 10/2018 and 9/2019. Patients were randomized to determine which liver lobe biopsied and which needle firstly used. The other needle would then be used to obtain a second specimen from the same lobe as the first pass. The primary outcome was complete portal tracts (CPTs), post-fix aggregate and longest specimen length. Secondary outcomes were pre-fix aggregate specimen length and the adequacy of the specimen judged by two expert pathologists. A total of 44 liver biopsies were performed in 22 patients. The most common indication for EUS-LB was abnormal liver function tests (16 of 22, 72.7%). The CPTs were higher in the Franseen needle group than in the fork-tip needle group (14.4 vs 9.5, p=0.043). Post-fix aggregate specimen length (44.9mm vs. 34.6mm, p=0.097), the post-fix longest specimen length (19.9mm vs. 13.7mm, p=0.175), and pre-fix aggregate specimen length (51.7mm vs. 45mm, p=0.265) and were not significantly different between 2 needles. Specimens were judged as mostly adequate in both needles (100% vs 95.5%, p=0.312). If we apply the criteria of CPTs ≥ 6 and length of the specimen above 15mm1 to the results, the ratio of “adequate specimen” was not significantly different between the two needles (95.5% vs. 77.3%, p=0.079). If we apply the AALSD guideline2, however, the Franseen needle group could get “adequate” specimen (CPT≥11 and the total length of the specimen 20mm) more than the fork-tip needle group (68.2% vs. 27.3%, p=0.015). Overall, both the 19G Franseen-tip needle and the 19G fork-tip needle appeared to yield enough tissue to establish a histologic diagnosis. The Franseen needle did appear to yield significantly higher numbers of CPTs compared to the fork-tip needle. We suspect adequacy of the specimen may further be augmented by performing additional actuations or passes during EUS-LB with these needles.