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Comparison of EUS-guided tissue acquisition using two different 19-gauge core biopsy needles: a multicenter, prospective, randomized, and blinded study.

DeWitt J, Cho CM, Lin J, Al-Haddad M, Canto MI, Salamone A, Hruban RH, Messallam AA, Khashab MA - Endosc Int Open (2015)

Bottom Line: Technical success, diagnostic histology, accuracy and complication rates were evaluated.Overall technical success and complication rates were comparable.EUS-FNB using a 19-gauge FNB needle is superior to 19-gauge EUS-TCB needle.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.

ABSTRACT

Background and study aims: The optimal core biopsy needle for endoscopic ultrasound (EUS) is unknown. The principle aim of this study is to compare outcomes of EUS-fine-needle biopsy (EUS-FNB) with a new 19-gauge EUS histology needle (ProCore, Cook Medical Inc., Winston-Salem, North Carolina, United States) to a conventional 19-gauge Tru-Cut biopsy (EUS-TCB) needle (19G, Quick-Core, Cook Medical Inc.).

Patients and methods: Patients referred for EUS who require possible histologic biopsy were prospectively randomized to EUS-FNB or EUS-TCB. With the initial needle, ≤ 3 biopsies were obtained until either technical failure or an adequate core was obtained. Patients with suspected inadequate biopsies were crossed over to the other needle and similarly ≤ 3 passes were obtained until adequate cores or technical failure occurred. Technical success, diagnostic histology, accuracy and complication rates were evaluated.

Results: Eighty-five patients (mean 58 years; 43 male) were randomized to FNB (n = 44) and TCB (n = 41) with seven patients excluded. Procedure indication, biopsy site, mass size, number of passes, puncture site, overall technical success and adverse events were similar between the two groups. FNB specimens had a higher prevalence of diagnostic histology (85 % vs. 57 %; P = 0.006), accuracy (88 % vs. 62 %; P = 0.02), mean total length (19.4 vs. 4.3 mm; P = 0.001), mean complete portal triads from liver biopsies (10.4 vs. 1.3; P = 0.0004) and required fewer crossover biopsies compared to those of TCB (2 % vs. 65 %; P = 0.0001). Overall technical success and complication rates were comparable.

Conclusion: EUS-FNB using a 19-gauge FNB needle is superior to 19-gauge EUS-TCB needle.

No MeSH data available.


Related in: MedlinePlus

 EUS. a Linear endoscopic ultrasound demonstrating a 6 x 5 cm hypoechoic, well defined mass in the head of the pancreas. b Endoscopic ultrasound with Tru-Cut biopsy using a 19-gauge needle (Quick-Core; Cook Medical, Inc.; Winston-Salem, North Carolina, United States) of the pancreatic head mass. c Endoscopic ultrasound exam after needle fracture showing 2.7 cm of the needle within the pancreatic head. d Picture of the fractured needle protruding through the sheath. e Non-contrast axial CT demonstrating the fractured needle within the pancreatic head. After surgical consultation, the patient did not require hospitalization. The needle was removed uneventfully during pancreatoduodenectomy six weeks later. Pathology demonstrated chronic pancreatitis without malignancy.
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FI206-2:  EUS. a Linear endoscopic ultrasound demonstrating a 6 x 5 cm hypoechoic, well defined mass in the head of the pancreas. b Endoscopic ultrasound with Tru-Cut biopsy using a 19-gauge needle (Quick-Core; Cook Medical, Inc.; Winston-Salem, North Carolina, United States) of the pancreatic head mass. c Endoscopic ultrasound exam after needle fracture showing 2.7 cm of the needle within the pancreatic head. d Picture of the fractured needle protruding through the sheath. e Non-contrast axial CT demonstrating the fractured needle within the pancreatic head. After surgical consultation, the patient did not require hospitalization. The needle was removed uneventfully during pancreatoduodenectomy six weeks later. Pathology demonstrated chronic pancreatitis without malignancy.

Mentions: All patients were followed for a minimum of 6 months. The prevalence of adverse events related to the FNB needle malfunction (1/41; 3 %) was similar to TCB needle malfunction (2/37; 5 %; P = 0.6; Table 5). In one patient with suspected type 2 autoimmune pancreatitis undergoing FNB of the tail of the pancreas, the needle would not retract into the sheath (likely from elevator deflection of the needle into a fibrotic gland) after the first attempted biopsy (Fig. 1 a – d). The endoscope and unretracted needle were removed together from the pancreas and out of the patient. Immediate reinsertion of the echoendoscope demonstrated retroperitoneal hemorrhage in the left upper quadrant which was confirmed by CT scan the same day (Fig. 1b – d). The patient had mild shoulder pain and was discharged less than 24 hours later without requiring blood transfusion. Pathology from FNB demonstrated chronic pancreatitis without evidence of autoimmune pancreatitis. Two patients with TCB had adverse events related to the needle. In the first, the distal 2 cm of the needle broke off inside the patient during plunger depression of the needle during the first attempted transduodenal biopsy of a pancreatic head mass (Fig. 2 a – e). The residual needle fragment was not visible with white light endoscopy but was confirmed by repeat EUS and non-contrast CT. After surgical consultation, the patient was discharged to home. Six weeks later the patient underwent pancreatoduodenectomy for treatment of the pancreatic mass and removal of the needle fragment. Pathology from surgical resection confirmed chronic pancreatitis. The second patient with an adverse event related to the TCB needle had the sheath-needle assembly break off at the accessory channel during biopsy of a pancreatic head mass. Pathology diagnosis from this first and only TCB pass as well as both crossover FNB biopsies demonstrated PET.


Comparison of EUS-guided tissue acquisition using two different 19-gauge core biopsy needles: a multicenter, prospective, randomized, and blinded study.

DeWitt J, Cho CM, Lin J, Al-Haddad M, Canto MI, Salamone A, Hruban RH, Messallam AA, Khashab MA - Endosc Int Open (2015)

 EUS. a Linear endoscopic ultrasound demonstrating a 6 x 5 cm hypoechoic, well defined mass in the head of the pancreas. b Endoscopic ultrasound with Tru-Cut biopsy using a 19-gauge needle (Quick-Core; Cook Medical, Inc.; Winston-Salem, North Carolina, United States) of the pancreatic head mass. c Endoscopic ultrasound exam after needle fracture showing 2.7 cm of the needle within the pancreatic head. d Picture of the fractured needle protruding through the sheath. e Non-contrast axial CT demonstrating the fractured needle within the pancreatic head. After surgical consultation, the patient did not require hospitalization. The needle was removed uneventfully during pancreatoduodenectomy six weeks later. Pathology demonstrated chronic pancreatitis without malignancy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612231&req=5

FI206-2:  EUS. a Linear endoscopic ultrasound demonstrating a 6 x 5 cm hypoechoic, well defined mass in the head of the pancreas. b Endoscopic ultrasound with Tru-Cut biopsy using a 19-gauge needle (Quick-Core; Cook Medical, Inc.; Winston-Salem, North Carolina, United States) of the pancreatic head mass. c Endoscopic ultrasound exam after needle fracture showing 2.7 cm of the needle within the pancreatic head. d Picture of the fractured needle protruding through the sheath. e Non-contrast axial CT demonstrating the fractured needle within the pancreatic head. After surgical consultation, the patient did not require hospitalization. The needle was removed uneventfully during pancreatoduodenectomy six weeks later. Pathology demonstrated chronic pancreatitis without malignancy.
Mentions: All patients were followed for a minimum of 6 months. The prevalence of adverse events related to the FNB needle malfunction (1/41; 3 %) was similar to TCB needle malfunction (2/37; 5 %; P = 0.6; Table 5). In one patient with suspected type 2 autoimmune pancreatitis undergoing FNB of the tail of the pancreas, the needle would not retract into the sheath (likely from elevator deflection of the needle into a fibrotic gland) after the first attempted biopsy (Fig. 1 a – d). The endoscope and unretracted needle were removed together from the pancreas and out of the patient. Immediate reinsertion of the echoendoscope demonstrated retroperitoneal hemorrhage in the left upper quadrant which was confirmed by CT scan the same day (Fig. 1b – d). The patient had mild shoulder pain and was discharged less than 24 hours later without requiring blood transfusion. Pathology from FNB demonstrated chronic pancreatitis without evidence of autoimmune pancreatitis. Two patients with TCB had adverse events related to the needle. In the first, the distal 2 cm of the needle broke off inside the patient during plunger depression of the needle during the first attempted transduodenal biopsy of a pancreatic head mass (Fig. 2 a – e). The residual needle fragment was not visible with white light endoscopy but was confirmed by repeat EUS and non-contrast CT. After surgical consultation, the patient was discharged to home. Six weeks later the patient underwent pancreatoduodenectomy for treatment of the pancreatic mass and removal of the needle fragment. Pathology from surgical resection confirmed chronic pancreatitis. The second patient with an adverse event related to the TCB needle had the sheath-needle assembly break off at the accessory channel during biopsy of a pancreatic head mass. Pathology diagnosis from this first and only TCB pass as well as both crossover FNB biopsies demonstrated PET.

Bottom Line: Technical success, diagnostic histology, accuracy and complication rates were evaluated.Overall technical success and complication rates were comparable.EUS-FNB using a 19-gauge FNB needle is superior to 19-gauge EUS-TCB needle.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.

ABSTRACT

Background and study aims: The optimal core biopsy needle for endoscopic ultrasound (EUS) is unknown. The principle aim of this study is to compare outcomes of EUS-fine-needle biopsy (EUS-FNB) with a new 19-gauge EUS histology needle (ProCore, Cook Medical Inc., Winston-Salem, North Carolina, United States) to a conventional 19-gauge Tru-Cut biopsy (EUS-TCB) needle (19G, Quick-Core, Cook Medical Inc.).

Patients and methods: Patients referred for EUS who require possible histologic biopsy were prospectively randomized to EUS-FNB or EUS-TCB. With the initial needle, ≤ 3 biopsies were obtained until either technical failure or an adequate core was obtained. Patients with suspected inadequate biopsies were crossed over to the other needle and similarly ≤ 3 passes were obtained until adequate cores or technical failure occurred. Technical success, diagnostic histology, accuracy and complication rates were evaluated.

Results: Eighty-five patients (mean 58 years; 43 male) were randomized to FNB (n = 44) and TCB (n = 41) with seven patients excluded. Procedure indication, biopsy site, mass size, number of passes, puncture site, overall technical success and adverse events were similar between the two groups. FNB specimens had a higher prevalence of diagnostic histology (85 % vs. 57 %; P = 0.006), accuracy (88 % vs. 62 %; P = 0.02), mean total length (19.4 vs. 4.3 mm; P = 0.001), mean complete portal triads from liver biopsies (10.4 vs. 1.3; P = 0.0004) and required fewer crossover biopsies compared to those of TCB (2 % vs. 65 %; P = 0.0001). Overall technical success and complication rates were comparable.

Conclusion: EUS-FNB using a 19-gauge FNB needle is superior to 19-gauge EUS-TCB needle.

No MeSH data available.


Related in: MedlinePlus