Su1378 Procore Histology Needles (19-Gauge and 22 Gauge) vs Standard Cytology Needles (22-Gauge and 25-Gauge) in the Differential Diagnosis of Solid Pancreatic Tumors

Abstract

Su1378 Procore Histology Needles (19-Gauge and 22 Gauge) vs Standard Cytology Needles (22-Gauge and 25-Gauge) in the Differential Diagnosis of Solid Pancreatic Tumors Julio Iglesias-Garcia, Ihab Abdulkader, Raquel Souto, Jose Larino-Noia, Jeronimo Forteza, Enrique Dominguez-Munoz Gastroenterology, University Hospital of Santiago, Santiago de Compostela, Spain; Foundation for Research in Digestive Diseases, Santiago de Compostela, Spain; Pathology, University Hospital of Santiago, Santiago de Compostela, Spain Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an efficacious technique for sampling pancreatic solid lesions. However, cytology possesses limitations to its final yield and accuracy, which may be overcome if histological specimens are provided to the pathologist. Aim of the study was to evaluate the accuracy of the newly developed 19-gauge and 22-gauge Procore needles, compare to the standard FNA needles. Methods: 83 consecutive patients (mean age 65.5 10.6 years, range 42-86, 47 male), who underwent EUS for the evaluation of solid pancreatic masses were prospectively included in the study. EUS were performed using a convex array echoendoscope (Pentax EG-3870UTK), connected to an ultrasound equipment (Hitachi). Biopsies were performed with the new 19-gauge and 22-gauge Procore needles (Cook Medical Inc, Limerick Ireland). FNA were performed with the standard 22-gauge and 25-gauge (Cook Medical Inc, Limerick Ireland). With Procore needles, sample obtained was recovered into cytolit and processed for histological analysis, after one pass. With standard cytology needles, samples were recoverd into slides and fixed for cytological evaluation, following the standard methodology. Results were compared to the gold standard of surgical histopathology, or global clinical and radiological assessment and follow-up in non-operated cases. Results are shown as mean or percentage (95%CI), and compared by chi-square test. Diagnostic accuracy was also evaluated. Results: Size of solid pancreatic masses was 41.5 19.8 mm (mean SD). 50 tumors were located in the head of the pancreas, 29 in the body, and 4 in the tail. 38 punctures (45.8%) were performed with Procore needles (21 with 19-gauge and 17 with 22-gauge), and 45 (54.2%) with standard cytology needles (25 with 25gauge and 20 with 22-gauge). In 36 cases (85.96%) diagnosis proved to be correct with Procore needles (94.7%) (16/17 with 22-gauge, and 20/21 with 19gauge), while with the standard needles diagnosis proved to be correct in 36 cases (80.0%) (15/20 with 22-gauge, and 21/25 with 25-gauge) (p 0.046). Conclusion: Performing a EUS-guided biopsy with the new Procore needles is more accurate than with the standard cytology needles.