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.
|Technical success (%)||100||84|
|Diagnostic yield (%)||94||33|
|Sufficiency for ancillary studies (%)||78||67|