22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy

David Karsenti; Laurent Palazzo; Bastien Perrot; Jacqueline Zago; Anne-Isabelle Lemaistre; Jérôme Cros; Bertrand Napoléon

doi:10.1055/a-1160-5485

Endoscopy, Table of Contents

Endoscopy 2020; 52(09): 747-753
DOI: 10.1055/a-1160-5485

Original article

22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy

David Karsenti

¹Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique de Paris-Bercy, Charenton-le-Pont, France

,

Laurent Palazzo

²Digestive Endoscopy Unit, Clinique du Trocadéro, Paris, France

,

Bastien Perrot

³UMR1246_SPHERE Methods for Patient-Centered Outcomes and Health Research, Nantes University, France

,

Jacqueline Zago

⁴Pathology Department, 29 rue du Colisée, Paris, France

,

Anne-Isabelle Lemaistre

⁵Department of Pathology, Eurofins Biomnis, Lyon, France

,

Jérôme Cros

⁶Beaujon Hospital, Pathology Department, Université de Paris, INSERM U1149, Clichy, France

,

Bertrand Napoléon

⁷Digestive Endoscopy Unit, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France

› Author Affiliations

Abstract

Background Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been suggested for obtaining high quality tissue samples from pancreatic tumors. We performed a multicenter randomized crossover trial comparing EUS-FNB with a 20G Procore needle vs. a 22G Acquire needle. The aims were to compare the quantity of targeted tissue (pancreas) and diagnostic accuracy for the two needles.

Methods 60 patients admitted for EUS-FNB in three endoscopy units were included. One pass was performed consecutively with each needle, in a randomized order. Histologic material was studied in a blinded manner with respect to the needle. The primary end point was mean cumulative length of tissue core biopsies per needle pass.

Results Final diagnosis was adenocarcinoma (n = 46; 77 %), neuroendocrine neoplasm (n = 11; 18 %), autoimmune pancreatitis (n = 2), and mass-forming chronic pancreatitis (n = 1). The mean cumulative length of tissue core biopsies per needle pass was significantly higher with the 22G Acquire needle at 11.4 mm (95 % confidence interval [CI] 9.0 – 13.8] vs. 5.4 mm (95 %CI 3.8 – 7.0) for the 20G Procore needle (P < 0.001), as was the mean surface area (3.5 mm² [95 %CI 2.7 – 4.3] vs. 1.8 mm²[95 %CI 1.2 – 2.3]; P < 0.001). Diagnostic adequacy and accuracy were 100 % and 87 % with the 22G Acquire needle, and 82 % and 67 % with the 20G Procore needle (P = 0.001 and P = 0.02, respectively).

Conclusions EUS-guided biopsy of pancreatic masses with the 22G Acquire needle provided more tissue for histologic evaluation and better diagnostic accuracy than the 20G Procore needle.

Full Text

References

References
1 Fritscher-Ravens A, Topalidis T, Bobrowski C. et al. Endoscopic ultrasound-guided fine-needle aspiration in focal pancreatic lesions: a prospective intraindividual comparison of two needle assemblies. Endoscopy 2001; 33: 484-490
2 Savides TJ, Donohue M, Hunt G. et al. EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement. Gastrointest Endosc 2007; 66: 277-282
3 Arewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol 2002; 97: 1386-1391
4 Eloubeidi MA, Chen VK, Eltoum IA. et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol 2003; 98: 2663-2668
5 Song TJ, Kim JH, Lee SS. et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol 2010; 105: 1739-1745
6 Bang JY, Hebert-Magee S, Trevino J. et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
7 Vanbiervliet G, Napoléon B, Saint Paul MC. et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46: 1063-1070
8 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48: 339-349
9 Khan MA, Grimm IS, Ali B. et al. A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment. Endosc Int Open 2017; 5: E363-E375
10 Dähnert WF, Hoagland MH, Hamper UM. et al. Fine-needle aspiration biopsy of abdominal lesions: diagnostic yield for different needle tip configurations. Radiology 1992; 185: 263-268
11 Swischuk JL, Castaneda F, Patel JC. et al. Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions. J Vasc Interv Radiol 1998; 9: 347-352
12 Lang EK, Macchia RJ, Gayle B. et al. CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management. Eur Radiol 2002; 12: 2518-2524
13 Keulers A, Cunha-Cruz VC, Bruners P. et al. Bone biopsy needles: mechanical properties, needle design and specimen quality. Rofo 2011; 183: 274-281
14 Bang JY, Hebert-Magee S, Hasan MK. et al. Endoscopic ultrasonography-guided biopsy using a Franseen needle design: Initial assessment. Dig Endosc 2017; 29: 338-346
15 Leung KiEL, Lemaistre AI, Fumex F. et al. Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation. Endosc Int Open 2019; 7: E189-E194
16 Karsenti D, Tharsis G, Zeitoun JD. et al. Comparison of 20-gauge Procore^® and 22-gauge Acquire^® needles for EUS-FNB of solid pancreatic masses: an observational study. Scand J Gastroenterol 2019; 54: 499-505
17 Bang JY, Magee SH, Ramesh J. et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-450
18 Eloubeidi MA, Tamhane A, Varadarajulu S. et al. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc 2006; 63: 622-629
19 Mirnezami R, Nicholson J, Darzi A. Preparing for precision medicine. NEJM 2012; 366: 489-491
20 Larghi A, Verna EC, Ricci R. et al. EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study. Gastrointest Endosc 2011; 74: 504-510
21 Iwashita T, Yasuda I, Mukai T. et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study). Gastrointest Endosc 2015; 81: 177-185
22 Van Riet PA, Larghi A, Attili F. et al. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device. Gastrointest Endosc 2019; 89: 329-339
23 Kandel P, Tranesh G, Nassar A. et al. EUS-guided fine needle biopsy sampling using a novel fork-tip needle: a case-control study. Gastrointest Endosc 2016; 84: 1034-1039
24 Jovani M, Abidi WM, Lee LS. Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study. Scand J Gastroenterol 2017; 52: 784-787
25 Kurita A, Yasukawa S, Zen Y. et al. Comparison of a 22-gauge Franseen-tip needle with a 20-gauge forward-bevel needle for the diagnosis of type 1 autoimmune pancreatitis: a prospective, randomized, controlled, multicenter study (COMPAS study). Gastrointest Endosc 2020; 91: 373-381.e2
26 Bang JY, Hebert-Magee S, Navaneethan U. et al. EUS-guided fine needle biopsy of pancreatic masses can yield true histology. Gut 2018; 67: 2081-2084
27 Bang JY, Hebert-Magee S, Navaneethan U. et al. Randomized trial comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy sampling of solid pancreatic mass lesions. Gastrointest Endosc 2018; 87: 1432-1438