Diagnostic accuracy and safety of the new three-pronged asymmetric-tip needles biopsy and cytological needles for EUS-guided tissue acquisition

Aims Endoscopic ultrasound-guided tissue acquisition (EUS-TA) represents the cornerstone modality for the assessment of pancreatic masses and other extraintestinal and intramural lesions. Several desing or size of cytological (FNA) and histological (FNB) needles are available. To evaluate the diagnostic accuracy and safety of new cytological (Areus Premium) and histological three-pronged asymmetric-tip needles (Trident) (Microtech, Nanjing, China).

Methods Retrospective, single-center study that included all EUS-TA performed in our center, from April 2021 to June 2024. Sensitivity, specificity, positive and negative predictive value (PPV and NPV) and diagnostic accuracy were evaluated, using the histology of the surgical specimen, clinical-radiological evaluation and follow-up as the gold standard for benignity/malignancy. Material: Pentax EG-3870 UTK linear echoendoscopes, Arietta V70 ultrasound processor, 19-gauge and 22-gauge FNA and FNB needles.

Results One hundred one EUS-TA were performed (mean age 62 years, range 23-92, 60% male). Twenty-two pancreatic cysts and 4 liver biopsies were excluded. Seventy-five patients were evaluated: 53 pancreatic masses (70%), 8 lymph node, 6 mediastinal masses, 5 subepithelial gastric lesions, 1 focal hepatic lesion, 1 ampullary lesion and 1 adrenal mass. Thirty-six FNB and 39 FNA were performed. Rapid On-site Evaluation (ROSE): 70 (93%). Median number of passes: 2 (1-4). Specimen quality: adequate in 63 punctures (84%). Aspiration technique: dry (61%), capillarity “slow pull technique” (39%). Cytohistological results were categorized as benign, atypical, suspicious, positive for malignancy and non-diagnostic. FNB: Sensitivity 94%, specificity 100%, PPV 100%, NPV 71% and diagnostic accuracy 94%. FNA: Sensitivity 76%, specificity 100%, PPV 100%, NPV 29% and diagnostic accuracy 74%. Complications: mild bleeding resolved endoscopically.

Conclusions The new three-pronged asymmetric-tip histological needles (FNB) and new cytological needles (FNA) offer high diagnostic accuracy and safety. Their results are similar to those obtained with other needles.

Publication History

Article published online:
27 March 2025