EchoTip ProCore Research Articles

Endoscopic Ultrasound-Guided Tissue Acquisition Versus Fine Needle Aspiration for Diagnosis of Pancreatic Ductal Adenocarcinoma.

Compare the 22Gneedle versus EchoTip ProCore® 20(Cook Medical, Bloomington, IN, USA) on their handling, specimen suitability, amount of tissue obtained, diagnostic performance, the possibility of immunohistochemistry, and rate of adverse events. This is a retrospective, comparative study of consecutively examined patients with pancreatic masses who underwent endosonography-guided fine needle aspiration (FNA) via the 22G needle, and endosonography-guided tissue acquisition (TA) via ProCore 20 (PC20). The operator evaluated needle insertion and subjectively classified the specimen. The pathologist measured the samples, classified the amount of tissue, and determined the influence of bleeding on the interpretation. A total of 129 patients participated in the study, out of whom 52 underwent endosonography-guided FNA with 22G and 77 underwent endosonography-guided TA with a PC20 needle. Malignant lesions were found in 106, and 23 had benign lesions. The duodenal route was used in 62% of patients. The 22G needle was easier to introduce (p=0.0495). However, PC20 obtained a larger amount (p<0.01) with fewer punctures (p<0.001). The PC20 also yielded a larger average microcore diameter (p=0.0032). Microhistology was adequate for 22G and PC20 in 22 (42.2%) and 50 (78.1%) specimens, respectively (p<0.001). Bleeding was not significantly different (p>0.999). Immunohistochemistry was possible in 36 (69.2%) and 40 (51.9%) specimens obtained by 22G and PC20, respectively (p=0.075). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 22G were 93.5%, 100%, 100%, 66.7%, and 94.2%, respectively; and for PC20, it was 95%, 100%, 100%, 85%, and 96.1%, respectively. Mild bleeding was the most common early adverse event, occurring in 2/52 (3.8%) 22G and 4/77 (5.2%) PC20 cases (p>0.05). The PC20 required fewer punctures and reduced the need for immunohistochemistry as it yielded better and larger microcores. Its ease of insertion into the target lesion makes it a good option to obtain satisfactory microcore specimens in difficult positions, such as the transduodenal route.

EUS-guided hepaticogastrostomy in multimetastatic liver disease - an effective approach for biliary drainage that may complement ERCP.

A 36-year-old male was diagnosed with a metastasized colon adenocarcinoma causing obstructive jaundice. Magnetic resonance cholangiography showed a dominant lesion causing hilar stenosis. The patient was submitted to endoscopic retrograde cholangiopancreatography (ERCP), nevertheless it was just possible to place a single uncovered self-expandable metallic stent (SEMS) in the right lobe. Although cholestasis significantly improved, safe levels for oncologic therapy were not reached. EUS-guided hepaticogastrostomy was proposed to complement ERCP biliary drainage. Using a forward-viewing echoendoscope and a transgastric approach, EUS-guided puncture of a dilated left intrahepatic duct at segment III was accomplished with a 19G needle (EchoTip ProCore®) that allowed passage of a 0.035 guidewire. A 6F cystotome and biliary dilators (5Fr+8.5Fr) were used for needle tract dilation. A partially-covered SEMS (GIOBOR™ 8x100mm) could be deployed under endoscopic and fluoroscopic control, being placed 3cm inside the gastric lumen. No associated complications were observed after the procedure.

Examination of endobronchial ultrasound-guided transbronchial needle aspiration using a puncture needle with a side trap

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing hilar and mediastinal lymph node enlargement; however, specimens obtained are often small and inadequate for pathologic diagnosis. In June 2017, EchoTip ProCore, a puncture needle with a side trap, was launched in Japan. In this single-center prospective interventional study, 57 patients with lymph nodes, intrapulmonary tumor or pleural mass were diagnosed using EBUS-TBNA with EchoTip ProCore between June 2017 and February 2020. EBUS-TBNA was performed for 57 patients and 53 patients had sufficient specimen for histologic diagnosis. The following pathologic subtypes were diagnosed: non-small cell lung cancer, 22; small cell lung cancer, 8; cancer of unknown primary, 2; neuroendocrine tumor (G2) recurrence, 1; lymphoma, 2; metastatic renal cell carcinoma, 3; thymoma recurrence, 1; sarcoidosis, 4; tuberculosis, 1; and non-malignancy, 9. In addition, the cytology showed Class V in 31 out of 57 cases (54.4%). In total, a definitive pathological diagnosis was obtained in 50 out of 57 cases (87.7%). The only complication was pneumonia caused by BAL simultaneously combined with EBUS-TBNA in one patient. Among 13 patients with inadequate specimens or without malignancy, only one patient was subsequently diagnosed with malignancy, and the median follow-up period was 300 days. EBUS-TBNA using EchoTip ProCore can obtain a sufficient specimen size for pathologic diagnosis.

Effectiveness of introducing a 20-gauge core biopsy needle with a core trap in EUS-FNA/B for diagnosing pancreatic cancer

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.

Endobronchial ultrasound guided Echo Tip Ultra HD 22G needle versus Echo Tip Pro Core HD 22G needle in diagnosis of mediastinal lesions

BackgroundConvex probe endobronchial ultrasound is a minimally invasive technique used for performing real-time transbronchial needle aspiration of enlarged hilar and mediastinal lymph nodes and could be used for diagnosing proximal peribronchial lesions. Although computed tomography, magnetic resonant imaging, and positron emission tomography/computed tomography have relatively high sensitivity for mediastinal evaluation, pathology is the gold standard. This study compared between Echo Tip Ultra HD-EBUS 22G needle and Echo Tip ProCore HD-EBUS 22G needle in diagnosis of mediastinal lesions using convex probe endobronchial ultrasound.ResultsTwenty-four patients with mediastinal lesions were included. Convex probe endobronchial ultrasound-guided transbronchial needle aspiration using both Echo Tip Ultra HD 22G and Echo Tip ProCore HD 22G needles was done to all patients with no peripheral lymph node enlargement. CP-EBUS TBNA had diagnostic accuracy 50%, sensitivity 47.6%, and specificity 100% in diagnosis of mediastinal lesions. The Echo Tip Ultra HD needle had diagnostic accuracy 40.9%, sensitivity 38%, and specificity 100% compared to the Echo Tip ProCore HD needle which had diagnostic accuracy 31.8%, sensitivity 82.5%, and specificity 100%. The difference between both needles was statistically insignificant. The Echo Tip Ultra 22G HD needle had more representative cellularity (82%) compared to the Echo Tip ProCore 22G HD needle (45%) with a significant difference between both needles (p value = 0.001).ConclusionBoth needles can be used equally in sampling mediastinal lesions. This study supports that Echo Tip Ultra HD and Echo Tip ProCore HD needles can be used equally in sampling of mediastinal lesions and supports ultrasound screening of enlarged supraclavicular and cervical lymph nodes before performing EBUS-TBNA in patients with mediastinal lesions.

Diagnostic Yield of Novel EUS-Guided Liver Biopsy Needles in an Ex vivo Model

Introduction: There is growing interest and efficacy testing in EUS-guided liver biopsy as an alternative to the percutaneous or transjugular approach. We aimed to test the diagnostic yield of novel 19G and 22G FNB needles to existing EUS needles in an ex vivo liver model. This is the first study to evaluate the histologic yield of the Acquire 22G EUS-FNB (Boston Scientific) and EZ Shot 3Plus 19G/22G needles (Olympus). Methods: We evaluated the Acquire 22G, SharkCore 19G/22G (Medtronic), EZ Shot 3Plus 19G/22G and EchoTip ProCore 20G (Cook) needles. Using an ex vivo cow liver model, each needle was passed through an Olympus echoendoscope to obtain a fine-needle aspirate or core biopsy. A flexed scope position was used to approximate in vivo tissue acquisition. Each needle underwent 10 passes, alternating between a slow pull of the stylet and 10mL suction on a syringe. 5 actuations per needle puncture were performed, with 4cm needle advancement per actuation. Primary outcome was the number of portal tracts obtained per needle aspirate. Secondary outcome was total linear specimen length. Pairwise comparisons between needle types and ‘slow-pull' vs. syringe suction techniques were performed using t-tests (p < 0.05 significance). Results: The mean number of portal tracts obtained per needle aspirate for each needle type was: SharkCore 19G (2.45+/-1.00), SharkCore 22G (1.10+/-0.55), Acquire 22G (1.70+/-0.80), EZ Shot 3Plus 19G (1.25+/-0.39), EZ Shot 3Plus 22G (0+/-0) and EchoTip ProCore 20G (1.30+/-0.51). The Shark-Core 19G yielded a significantly increased mean number of portal tracts compared with all needle types, with the exception of the Acquire 22G (Table 1). Among 22G needles, the Acquire 22G yielded the highest number of portal tracts (Table 1). The Acquire 22G portal tract yield was not statistically different from the SharkCore 19G (p=0.17) and EZ Shot 3Plus 19G (p=0.17). There was no statistical difference in tissue length between slow-pull and suction methods; however, the slow-pull method yielded a significant increase in portal tracts in Acquire 22G (p=0.02) and SharkCore 22G (p=0.03) needles.Table: Table. Comparison of Portal Tract Yield Amongst Needle TypesConclusion: Compared to other 19G and 20G EUS core needles, the SharkCore 19G EUS-FNB needle yielded the highest number of portal tracts. Among the 22G needles, the novel Acquire 22G EUS-FNB needle yielded the highest number of portal tracts. The Acquire 22G was not statistically different from the SharkCore 19G and EZ Shot 3Plus 19G with regards to portal tract yield.

Side-beveled fine needle biopsy needles improve positive cytology rate in endoscopic ultrasound-guided sampling of pancreatic solid lesions

Background and Objectives:In the perspective of improving accuracy of endoscopic ultrasound (EUS)-guided sampling, the efforts of innovation have focused on needle design, with the development of micro-core acquisition technology, and puncture technique variations. Available studies have shown that fine needle biopsy (FNB) needles can achieve a satisfactory diagnostic yield after fewer passes when compared to fine needle aspiration (FNA) needles, without an overall diagnostic advantage. Limited data are available to explain these results. We compared FNA and side-beveled FNB needles for micro-core/cellular material retrieval and diagnostic performance in pancreatic solid lesions.Methods:This was a single-center retrospective study of 110 consecutive patients who underwent EUS-sampling for a solid pancreatic lesion. All cellular material was collected for cell-block construction. The cytological examination was performed according to Papanicolaou. KRAS analysis was used as an ancillary technique to resolve indeterminate cases. Sensitivity and specificity were calculated in FNA (EchoTip® Ultra) and in FNB (EchoTip ProCore®) categories. All cases were evaluated for cellularity and micro-core (fragment retaining tissue architecture) retrieval. We compared FNA and FNB needles of different diameter (FNA: 19, 22, and 25G and FNB: 20, 22, and 25G), as well as large (19–20G) and small bore needles (22–25G).Results:Considering only positive cytology as diagnostic for malignancy, FNB needles showed higher sensitivity than FNA needles (86.4% vs. 54.9%, P = 0.002). If KRAS-mutated indeterminate cases were considered as malignant, overall sensitivity was 94.7%. In subcategories (FNB vs. FNA), sensitivity was 97.7% versus 92.2%, P = 0.37. Micro-cores were present in 65.2% of FNB versus 15.1% of FNA samples (P < 0.0001), rising to 95.2% in 20G-FNB category, and in 88.5% of large bore versus 20.5% of small bore needles (P < 0.0001). Considering the overall amount of cellular material (micro-cores plus cellular aggregates), FNB needles were better than FNA (91.3% vs. 62.3%, P = 0.001). The needle diameter did not influence the overall amount of cellular material retrieval since a satisfactory amount could be retrieved in both categories (large vs. small bore needles: 88.5% vs. 71.2%, P = 0.063).Conclusions:FNB needles allowed a relevant improvement in positive cytology with reduced need of KRAS mutational assessment or ancillary techniques. Dedicating all cellular material to the construction of cell-blocks and high retrieval rate of micro-cores may explain these results.

A new needle on the block: EchoTip ProCore endobronchial ultrasound needle.

Endobronchial ultrasound has become the first choice standard of care procedure to diagnose benign or malignant lesions involving mediastinum and lung parenchyma adjacent to the airways owing to its characteristics of being real-time and minimally invasive. Although the incidence of lung cancer has been decreasing, it is and will be the leading cause of cancer-related mortality in the next few decades. When compared to other cancers, lung cancer kills more females than breast and colon cancers combined and more males than colon and prostate cancers combined. The type of lung cancer has changed in recent decades and adenocarcinoma has become the most frequent cell type. Prognosis of lung cancer depends upon the cell type and the staging at the time of diagnosis. The cell type and molecular characteristics of adenocarcinoma may allow individualized targeted treatment. Other malignant conditions in the mediastinum and lung (eg, metastatic lung cancers and lymphoma) can be biopsied using endobronchial ultrasound needles. Endobronchial ultrasound needle biopsies provides mostly cytology specimens due to its small sizes of needles (22 gauge or larger) which may not give enough tissue to make a definitive diagnosis in malignant (eg, lymphoma) or benign conditions (eg, sarcoidosis). EchoTip ProCore endobronchial needle released in early 2014 provides histologic biopsy material. Larger tissue biopsies may potentially provide a higher diagnostic yield and it eliminates mediastinoscopy or other surgical interventions. Here we aim to review bronchoscopic approach in the diagnosis of mediastinal lesions with emphasis of EchoTip ProCore needles.

EUS Needle Identification Comparison and Evaluation study (with videos)

EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P< .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P< .001). All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.

PWE-008 Multicentre randomised trial comparing eus guided fine needle aspiration cytology (fnac) with fine needle aspiration biopsy (fna b) in sampling solid pancreatic mass lesions: preliminary results from the procore trial

Introduction EUS-guided FNA is the standard of care for tissue sampling of pancreatic lesions. The new Echo Tip ProCore biopsy needle (Cook Medical) was developed to obtain core tissue specimens for histological analysis improving the diagnostic yield and potentially obviating the need for onsite cytopathologist. Our aim was to compare the standard Echo tip ultra FNAC needle with the new Echo Tip Ultra ProCore FNAB needle in the sampling of solid pancreatic lesions. Method Randomised multicenter trial (REC Ref 12/EM/0189). All patients referred for EUS-guided tissue sampling of a solid pancreatic mass were invited to participate. Linear EUS (Aloka-Olympus/Hitachi-Pentax) was performed and patients were randomised to either FNAC or FNAB. Due to the nature of the study the endoscopist could not be blinded. A 22G needle was used when sampling from the stomach and a 25G from the duodenum. A maximum of 5 passes were allowed. Sampling time from first insertion of the needle into the lesion to the time the last tissue sample is transferred into the histology pot, number of passes and adequacy for diagnosis were recorded and included for analysis. Immediate and delayed complications were also recorded. Results 266 patients were recruited (median age 67 years, 52% men); 142 randomised to the FNAC group and 124 to the FNAB group. Two patients were excluded after randomization; no mass lesion was seen in 1 patient randomised to FNAC and the needle failed in 1 patient in the FNAB group and FNAC was performed. 264 patients were analysed, 141 in the FNAC group (22G=83 and 25G=58. Median max diameter of the lesion 34 mm, range 10–87 mm) and 123 in the FNAB group (22G=53 and 25G=71. Median max diameter 33 mm, range 8–85 mm). There was no statistical significant difference between groups in number of passes (median 4, range 1–5 in the FNAC group vs. median 3, range 1–5 in the FNAB group, p = 0.12), sampling time (median 13 min, range 1–32 min vs. median 13 min, range 2–42 min, p = 0.63) and adequacy of the specimen for diagnosis (90.8% vs. 87%, p = 0.33). Three technical failures were observed in the FNAB group and none in the FNAC cohort (1.6% vs. 0%, p = 0.99). No complications reported in either group. Conclusion FNAC and FNAB needles were comparable in terms of sampling time, number of passes, sample adequacy for diagnosis and safety. Technical failure was higher in the FNAB arm but not statistically significant. Disclosure of interest None Declared.

Mo1470 EUS-Guided Fine Needle Aspiration and Fine Needle Biopsy Under on-Site Cytopathological Evaluation for Gastric Subepithelial Tumor

Mo1470 EUS-Guided Fine Needle Aspiration and Fine Needle Biopsy Under on-Site Cytopathological Evaluation for Gastric Subepithelial Tumor

25-gauge histology needle versus 22-gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathy.

Background and study aims: A new 25-gauge (G) endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) device (EchoTip ProCore; Cook Medical, Bloomington, Indiana, USA) has been developed, which features a hollowed-out reverse bevel to trap core samples. However, data on the differences between the diagnostic yield of the 25G EchoTip ProCore and that of a 22G standard needle are limited. Patients and methods: This pilot study included 27 patients referred during an 11-month period for EUS-FNA of pancreatic masses and enlarged lymph nodes adjacent to the upper gastrointestinal tract. Each lesion was punctured once by both a 25G EchoTip ProCore needle and a 22G standard needle (EchoTip; Cook Medical) with capillary sampling. Blinded histocytologic analyses were conducted. The final diagnosis was based on FNA findings of malignant cells, pathologic analysis of the surgical specimen, and/or radiologic and clinical follow-up of at least 7 months. Results: A total of 28 EUS-FNA procedures targeting masses of the pancreas (n = 19) and lymph nodes (n = 9) were performed. No complications were encountered. Single-pass sensitivity rates for pancreatic and lymph node malignancy were equal for the needle types: 89.5 % (95 %CI 66.82 – 98.39) and 66 % (95 %CI 24.1 – 94), respectively. There were no significant differences between the needles in terms of EUS visualization (P = 0.125), amount of blood contamination (P = 0.705), macroscopic quantity of the material (P = 0.858), quality of the cytology (P = 0.438), and adequacy and accuracy of the cell block material (P = 0.220). Conclusions: Both needles were safe and successful in terms of a high diagnostic yield, with similar histocytologic results.The results of this study were presented at Digestive Disease Week (DDW) 2014, Chicago, Illinois.This trial was registered at ClinicalTrials.gov (B027201316271).

EUS‐guided 22‐gauge fine‐needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used for diagnosis of pancreatic lesions. The Echotip Procore Needle (Wilson-Cook Medical) is a new 22G fine biopsy needle (FNB) for obtaining core biopsy material at time of EUS. This study aimed to compare the technical and diagnostic performance of conventional FNA and FNB. Thirty-two patients met the design criteria for this prospective paired cohort study. All lesions sampled were solid (non-cystic) pancreatic masses by EUS appearance. Patients were randomized to receive FNA or FNB by first attempt. A cytopathologist performed on-site evaluations. Samples were assessed for accuracy of diagnosis, cellularity, contamination, and sufficiency for ancillary studies. Technical and diagnostic performances were compared. Compared to FNA, there was a statistically significant decreased ability of FNB to achieve a diagnosis (FNA 93.8%, FNB 28.1%, P < 0.001). FNB was diagnostically superior to FNA in 1 of 32 cases. Technical failures were observed in five cases due to resistance to advancement of the FNB needle. Regarding operator perceived ease-of-use, FNA outperformed FNB (P < 0.001). Eight cases had insufficient FNB material to survive tissue processing. There was no significant difference in mean specimen cellularity between devices. FNA samples showed an increased amount of contaminant (P = 0.036) but were more sufficient for ancillary studies (P = 0.502). Although deemed comparable to FNA when providing material for cytology, the pledged advantage of FNB acting like a core biopsy needle was not apparent in our series. Additional studies are needed before routine adoption of 22G FNB can be recommended.

Endoscopic Ultrasound-guided Liver Biopsy in a Pediatric Patient

Purpose: A 9-year-old female was referred due to crampy, diffuse abdominal pain and diarrhea for 6 months. She had four bowel movements a day associated with urgency and rectal bleeding. The patient denied any recent viral like illness, rash, fevers, jaundice, or joint pains. No family history of any IBD or liver disease. No recent travel. She had tried omeprazole but this did not relieve her symptoms. Her vitals including her weight was stable. Her BMI was 17. She had no icterus. Her abdomen was soft, flat, nondistended, liver was 2 cm below the right costal margin, no splenomegaly, no ascites, and she had normal bowel sounds. She had no perianal lesions and no rashes. On review of her labs, her Hb was 11 mg/dL with evidence of an iron deficiency anemia. Her AST was 216 U/L, ALT 289 U/L, Alk Phos 258 U/L, total bilrubin of 0.3 mg/dL, and an albumin of 4.0 g/dl. An extensive laboratory work up for her elevated liver enzymes was unrevealing, including acute hepatitis panel, ANA, anti-smooth muscle antibody, ceruloplasmin, alpha one antitrypsin, tissue transglutaminase, PT/INR, CRP, and TSH. An abdominal ultrasound revealed a normal appearing liver and gallbladder without intrahepatic ductal dilation. A colonoscopy revealed continuous inflammation from the rectum to the ascending colon consistent with ulcerative colitis. She was referred to our adult gastroenterology clinic for EUS-guided liver biopsy. We performed a core biopsy with a 19 gauge ultrasound biopsy needle (EchoTip ProCore; Cook Medical Inc., Bloomington, IN) with a transgastric approach of the left lobe of the liver and a transduodenal approach of the right lobe. The pathology revealed portal inflammation with edema and bile ductular reaction most likely due to downstream biliary obstruction. She had no procedural complications. We present this case to showcase the use of EUS-guided liver biopsy in pediatric patients. This technique has been shown in the past to be an effective and safe technique in adult patients.

Diagnostic Performance in Pancreatic Lesions of Different Methods of Endoscopic Ultrasound Fine Needle Aspiration

Purpose: Fine needle aspiration (FNA) guided by endoscopic ultrasound (EUS) is a very important method for the diagnosis of pancreatic lesions. The objective of this study was to evaluate the performance of our Department and determine the diagnostic accuracy of endoscopic ultrasound guided puncture in pancreatic lesions. Methods: Retrospective analysis of EUS with FNA of pancreatic lesions diagnosed between April 2010 and March 2013. Procedures were performed by two operators using the Olympus linear GF-UCT 140 and the Aloka Prosound Alpha 5 SV. Two different types of needles were used: Ultra Echotip and Echotip ProCore (Cook Medical). Antibiotic prophylaxis was carried out with ciprofloxacin in cystic punctures. Results: We have analysed 117 punctures, 72 (67%) in pancreatic lesions (79% of these were solid and 21% pancreatic cysts). Half of the patients were male, with an average age of 58± 14 years. The average size of the lesions was 38± 19mm. 61% of the lesions were located in the cephalopancreatic region, 26% in the body, 10% on the tail and 3% in the unciform process. Location did not affect the puncture success. We used 19 G needles in 34%, 22 G in 57% and 25G in 9%, obtaining appropriate material in 65% of the punctures (53% in cystic lesions and 69% in solid lesions). ProCore needles were used in 15 cases (14 with 22G needle). ProCore needles led to a diagnosis in 10 cases (67%). The most frequent diagnoses were adenocarcinoma (50%), nonspecific inflammatory processes (28%), IPMN (13%) and neuroendocrine tumor (9%). Procedures were performed with extemporaneous examination in 35% of cases; its implementation has led to a slight increase in diagnostic accuracy, not statistically significant (68% vs 64%; p=.723). Twenty five (39%) patients underwent surgery, and 22 (33%) needed (neo)adjuvant chemotherapy. Conclusion: FNA showed a significant diagnostic accuracy in pancreatic lesions obtaining suitable material in 2/3 of cases, enabling the establishment of an adequate therapy.

Addition of EUS-FNA and On-site Cytology to EUS-FNB Increases Procedure Time but Not Diagnostic Accuracy

Purpose: The diagnostic accuracy of EUS-FNA in non-pancreatic lesions is poor relative to pancreas adenocarcinoma; accuracy is improved with EUS-FNB. As histology is often needed in these lesions, it may be possible to forgo initial EUS-FNA and rapid on-site cytology evaluation (ROSE). The goal of this study was to compare the diagnostic accuracy of EUS-FNB alone with a conventional sampling algorithm of EUS-FNA with ROSE followed by EUS-FNB in non-pancreas adenocarcinoma lesions. Methods: Retrospective cohort study of subjects who underwent EUS sampling of non-pancreatic adenocarcinoma lesions over a 28-month time period (2/2011-5/2013) since introduction of new core biopsy needle (Echotip Procore, Cook Endoscopy, USA). Lesions included lymphadenopathy or retroperitoneal/mediastinal mass (LRMM), subepithelial mass (SEM), non-adenocarcinoma pancreas, or gastrointestinal wall thickening. Two cohorts were compared: EUS-FNB without EUS-FNA or ROSE (EUS-FNB group) and EUS-FNA with ROSE and if needed, EUS-FNB (EUS-FNA/B group). The primary outcome of this study was to compare diagnostic accuracy, defined as the percentage of total cases where an accurate cytologic or histologic diagnosis was achieved. The secondary outcome was total procedure time. Results: Over the study period, there were 96 lesions (43 in EUS-FNB, 53 in EUS-FNA/B groups). In the EUS-FNB cohort, SEM was the most common indication (48.8%) followed by LRMM (20.0%). In the cohort of EUS-FNA/B patients, LRMM (50.9%) was the most common indication followed by SEM (26.4%). Mean lesion size was similar between EUS-FNB and EUS-FNA/B groups (23.8 mm vs. 27.6mm; p=0.35). In the EUS-FNA/B group, a median of a 4±1.4 EUS-FNA passes were performed prior to either procedure termination or EUS-FNB. A diagnosis was obtained by EUS-FNA alone in nine patients (17.0%). Overall diagnostic accuracy was similar between the EUS-FNB and EUS-FNA/B groups (83.7% vs. 84.9%; p=NS; Table 1). In the subgroup of SEM lesions, diagnostic accuracy remained similar in the EUS-FNB and EUS-FNA/B groups (81.0% and 70.6%; p=0.7). In cases where only a single needle size was used, diagnostic accuracy was numerically greater when a 19-gauge needle was used compared to 22-gauge or 25-gauge needles (Table 2). EUS-FNB procedures were significantly shorter than those in the EUS-FNA/B group (58.4 min vs. 73.5 min; p<0.0001).Table 1: Diagnostic accuracyTable 2: Diagnostic accuracy of needle sizes (EUS-FNB only)Conclusion: EUS-FNB without ROSE has a high diagnostic accuracy in lesions where histology is likely needed. Addition of EUS-FNA and ROSE is associated with increased time and resource utilization but does not improve diagnostic accuracy. This data suggests EUS-FNB without ROSE may be the optimal technique for lesions other than pancreas adenocarcinoma. Disclosure - Dr. Keswani - Consultant, Cook Medical Dr. Komanduri - Consultant, Cook Medical.

Emerging Utility of a Dual-use 22-gauge (Cook EchoTip ProCore HD) Needle for Endoscopic Ultrasound-guided Cytologic and Histologic Sampling of Solid Pancreatic Lesions

Total 89 55 (62%) 34 (38%) Mutations 50 (56%) 34 (38%) 16 (18%) KRAS mutation 30 (33%) 18 (20%) 12 (13%) EGFR mutation 17 (19%) 13 (15%) 4 (4%) ALK 3 (3%) 3 (3%) 0 Insufficient 5 (5%) 4 (4%) 1 (1%) <1 cm 15 5 (33%) 10 (67%) Mutations 8 (53%) 2 (13%) 6 (40%) KRAS mutation 8 (53%) 2 (13%) 6 (40%) EGFR mutation 0 0 0 ALK mutation 0 0 0 Insufficient 2 (13%) 2 (13%) 0 1-2 cm 19 13 (68%) 6 (32%) Mutations 10 (53%) 7 (37%) 3 (16%) KRAS mutation 5 (26%) 3 (16%) 2 (10%) EGFR mutation 4 (21%) 3 (15%) 1 (6%) ALK mutation 1 (6%) 1 (6%) 0 Insufficient 0 0 0 2+ cm 55 37 (67%) 18 (33%) Mutations 32 (58%) 25 (45%) 7 (13%) KRAS mutation 17 (31%) 13 (23%) 4 (7%) EGFR mutation 13 (23%) 10 (18%) 3 (6%) ALK mutation 2 (14%) 2 (14%) 0 insufficient 3 (5%) 2 (3.7%) 1 (1.8%) S6 Abstracts

Mo1489 EUS Guided Fine Needle Aspiration (EUS-FNA) Versus Fine Needle Biopsy (EUS FNB): a Comparison of Technical Success, Efficacy and Cost Analysis for Pancreas Masses

EUS-FNA has high sensitivity and specificity for diagnosis of pancreas masses but is limited by inability to obtain sample for histology. EUS-FNB using newly available Echotip Procore needle can provide tissue for histology and has also shown high sensitivity and specificity. EUS-FNA routinely uses in-room cytology reading for immediate interpretation and sample is also sent for cellblock, with separate costs for both the portions. EUS-FNB samples are sent for histology and the FNB needle is $ 95 more expensive then FNA needle.

Su1530 Impact of Immediate Touch Prep Evaluation on the Diagnostic Accuracy of EUS-Guided Fine Needle Biopsy Using the EchoTip Procore Needle

EUS-guided fine needle biopsy (EUS-FNB) enables acquisition of tissue cores for histologic assessment. Touch prep (TP) is a technically simple procedure that allows for adequacy assessment; however, the value of TP, specifically immediate adequacy assessment, on the diagnostic accuracy of EUS-FNB has not yet been reported

Sa1575 Initial Experience With the Efficacy of Touch Prep in Endoscopic Ultrasound Guided Fine Needle Biopsy (EUS-FNB) Using EchoTip Procore Needle

Sa1575 Initial Experience With the Efficacy of Touch Prep in Endoscopic Ultrasound Guided Fine Needle Biopsy (EUS-FNB) Using EchoTip Procore Needle