Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses

Yousuke Nakai, Hiroyuki Isayama, Kenneth J Chang, Natsuyo Yamamoto, Tsuyoshi Hamada, Rie Uchino, Suguru Mizuno, Koji Miyabayashi, Keisuke Yamamoto, Kazumichi Kawakubo, Hirofumi Kogure, Takashi Sasaki, Kenji Hirano, Mariko Tanaka, Minoru Tada, Masashi Fukayama, Kazuhiko Koike
Digestive Diseases and Sciences 2014, 59 (7): 1578-85

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic masses is an established procedure for obtaining a pathological specimen. However, application of suction during EUS-FNA is still controversial and the efficacy of the slow-pull technique was recently reported for new core biopsy needles.

AIM: The purpose of this study was to compare the suction and slow-pull techniques using regular FNA needles.

METHODS: The diagnostic yield of the suction and slow-pull techniques was retrospectively studied for patients who underwent EUS-FNA for pancreatic solid lesions.

RESULTS: A total of 367 passes (181 by suction and 186 by the slow-pull technique) were performed during 97 EUS-FNA procedures for 93 patients with pancreatic solid lesions. The slow-pull technique resulted in lower scores for cellularity (≥2 for 37.5 % vs. 76.7 %) but scores for contamination with blood were lower (≥2 for 25.0 % vs. 66.7 %) and sensitivity of diagnosis of malignancy was higher (90.0 % vs. 67.9 %) when a 25-gauge FNA needle was used. There were no significant differences between the two techniques when a 22-gauge needle was used. In multivariate analysis of 82 cases with malignancy, the slow-pull technique (odds ratio (OR) 1.92, P = 0.028), tumor size ≥25 mm (OR 4.64, P < 0.001), and tumor location in the body or tail (OR 2.82, P < 0.001) were associated with greater sensitivity.

CONCLUSION: The slow-pull technique was associated with less contamination with blood and can potentially increase the diagnostic yield compared with the suction technique in EUS-FNA of pancreatic solid masses, especially with a 25-gauge FNA needle.

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