[384] Assessment of Diagnostic Yield of Traditional 22G FNA and Core Biopsy with the New 22G Echotip Procure Needle in Sampling of Solid Pancreatic Masses

Susanne K Jeffus, Daniel S Strand, Vanessa M Shami, Andrew Y Wang, Bryan G Sauer, Edward B Stelow. University of Virginia, Charlottesville, VA

Background: EUS-guided FNA is widely utilized for sampling and diagnosis of pancreatic lesions. The Echotip Procore Needle (EPN) (Wilson-Cook Medical) is a new 22G biopsy needle with reverse bevel designed to obtain core biopsy material with retrograde motion at time of EUS. The aim of this study was to compare the diagnostic yields of conventional EUS FNA and EPN.
Design: All pancreatic lesions included in this study were solid (>60%) pancreatic masses diagnosed on imaging and confirmed at time of EUS. All pancreatic lesions were sampled by both FNA and core biopsy. The patients were randomized to receive FNA (22G Echotip Ultra, Wilson-Cook Medical) or core biopsy (22G EPN, Wilson-Cook Medical) by first attempt. An on-site evaluation of all FNA material was performed. FNA material was processed per routine cytologic methods. Core biopsy material was formalin fixed, processed, paraffin embedded, and subsequently stained with hematoxylin and eosin. FNA and core biopsy material were assessed for accuracy of diagnosis, cellularity (0-3), presence of contamination (0-3), and sufficiency for ancillary studies. Diagnostic performances were compared.
Results: 32 patients (13 men, 19 women, mean age = 68 yrs) met the study criteria. 23 lesions were located in the head, 6 in the body, and 3 in the tail of the pancreas. FNA was performed first (before EPN) in 16 patients. FNA material was superior to core biopsy in reaching a diagnosis in 22 cases and was identical to EPN in diagnostic utility in 8 cases. Neither FNA nor EPN arrived at the correct diagnosis in 1 case. EPN was superior to FNA in only 1 patient with metastatic renal cell carcinoma to the pancreas. Further comparisons are summarized in Table 1.

FNA to EPN Comparison
Technical success (%)10084
Diagnostic yield (%)9433
Cellularity (mean)2.91.63
Contamination (mean)0.810.42
Sufficiency for ancillary studies (%)7867

Conclusions: In spite of functioning as a core biopsy needle, this study demonstrates that the technical success and diagnostic yield with the new 22G Echotip Procore needle is not comparable to traditional 22G FNA of solid pancreatic lesions sampled with EUS. Further studies may be helpful to establish the diagnostic utility of the EPN.
Category: Cytopathology

Tuesday, March 5, 2013 1:00 PM

Poster Session IV # 76, Tuesday Afternoon


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