The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses

Tae Jun Song, Ji Hoon Kim, Sang Soo Lee, Jun Bum Eum, Sung Hoon Moon, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Se Jin Jang, Sung Cheol Yun, Myung-Hwan Kim
American Journal of Gastroenterology 2010, 105 (8): 1739-45

OBJECTIVES: A large-caliber needle such as a 19-gauge needle may help overcome the limitations of a 22-gauge needle by acquiring a larger amount of tissue sample. However, there has been no well-designed comparative study for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a 19-gauge aspiration needle. We conducted this study to compare the diagnostic accuracy of EUS-FNA using a 19-gauge aspiration needle with that using a 22-gauge aspiration needle in patients with solid pancreatic/peripancreatic mass.

METHODS: From March 2007 to April 2008, a total of 117 patients (60 in a 19-gauge needle group and 57 in a 22-gauge needle group) with solid pancreatic/peripancreatic mass were included. EUS-FNA was performed using the standard technique without an on-site cytopathologist. A single, blinded cytopathologist retrospectively evaluated each set of slides.

RESULTS: The diagnostic accuracy by intention-to-treat analysis was not significantly different (19G: 86.7% vs. 22G: 78.9%, P=0.268). However, the diagnostic accuracy by per-protocol analysis, excluding technical failures, was significantly higher in the 19-gauge needle group (94.5% vs. 78.9%, P=0.015). In the treatment-received group that included crossover cases, although the diagnostic accuracy in all cases was not significantly different (86.1% vs. 76.9%, P=0.164), that of body/tail lesion (95.0% vs. 76.7%, P=0.031) and technically successful cases (93.9% vs. 78.1%, P=0.006) were significantly higher in the 19-gauge needle group. On sample quality analysis, the amount of cellular material obtained was significantly higher in the 19-gauge needle group (P=0.033).

CONCLUSIONS: EUS-FNA with a 19-gauge aspiration needle may be a valuable method for the diagnosis of pancreatic/peripancreatic masses when an on-site cytopathologist is not available.

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