Endoscopy 2020; 52(01): 37-44
DOI: 10.1055/a-0966-8755
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Combined versus single use 20 G fine-needle biopsy and 25 G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions

Priscilla A. van Riet
 1  Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
,
Paolo Giorgio Arcidiacono
 2  Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy
,
Mariachiara Petrone
 2  Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy
,
Nam Quoc Nguyen
 3  Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
,
Masayuki Kitano
 4  Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan
,
Kenneth Chang
 5  Comprehensive Digestive Disease Center, University of California, Irvine, California, United States
,
Alberto Larghi
 6  Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Julio Iglesias-Garcia
 7  Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
,
Marc Giovannini
 8  Institut Paoli-Calmettes, Marseilles, France
,
Schalk van der Merwe
 9  Department of Hepatology and Biliopancreatic Disease, University Hospital Leuven, Leuven, Belgium
,
Erwin Santo
10  Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
,
Francisco Baldaque-Silva
11  Gastro Center, Karolinska University Hospital, Huddinge, Sweden
,
Juan Carlos Bucobo
12  Division of Gastroenterology, Stony Brook University Hospital, New York, New York, United States
,
Marco J. Bruno
 1  Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
,
Harry R. Aslanian
13  Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, United States
,
Djuna L. Cahen*
 1  Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
,
James Farrell*
13  Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, United States
› Author Affiliations
TRIAL REGISTRATION: Partially randomized multicenter study trial NCT02167074 at clinicaltrials.gov
Further Information

Publication History

submitted: 09 February 2019

accepted after revision: 12 June 2019

Publication Date:
22 July 2019 (online)

Abstract

Background Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine-needle aspiration (FNA) and fine-needle biopsy (FNB) consecutively. We explored the yield of combined use of 20 G FNB and 25 G FNA needles in patients with a suspicious solid gastrointestinal lesion.

Methods Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches – FNA followed by FNB, and vice versa.

Results 73 patients were included. There were 39 (53 %) pancreatic lesions, 18 (25 %) submucosal masses, and 16 (22 %) lymph nodes. FNA was used first in 24 patients (33 %) and FNB was used first in 49 (67 %). Generally, FNB was performed after FNA to collect tissue for ancillary testing (75 %), whereas FNA was used after FNB to allow for on-site pathological assessment (76 %). Diagnostic accuracy for malignancy of single needle use increased from 78 % to 92 % with dual sampling (P = 0.002). FNA followed by FNB improved the diagnostic accuracy for malignancy (P = 0.03), whereas FNB followed by FNA did not (P = 0.13).

Conclusion Dual sampling only improved diagnostic accuracy when 25 G FNA was followed by 20 G FNB and not vice versa. As the diagnostic benefit of the 20 G FNB over the 25 G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice.

* These authors contributed equally to this work.