An experimental study to assess the best maneuver when using a reverse side-bevel histology needle for EUS-guided fine-needle biopsy

Background and study aims: Recently, ProCore™ was developed as an endoscopy ultrasound (EUS)-guided histology needle designed to address several current limitations of EUS-guided fine-needle aspiration (FNA). Nevertheless, tissue yield with the ProCore™ is not consistent. No standard technique has been established. This experimental study was conducted to ascertain the best maneuver when using the ProCore™.

Patients and methods: We performed fine-needle aspiration and biopsy (FNAB) with a 22-gauge (G) ProCore™ using chicken tenderloin and liver. Six methods were used, with two needle movement techniques (natural speed and whipping back) and three negative pressures (no suction (NS), slow pull (SP), and 10-mL suction).

Results: In cases using the “natural speed” technique, a significant difference in tissue yield was found with suction pressures in both tenderloin and liver (P < 0.0001, P = 0.0079). In cases using the “whipping back” technique, for the tenderloin, no significant difference in tissue yield was found for NS vs. SP (P = 0.0596), however, a significant difference was found for SP vs. 10-mL suction (P < 0.0001) and for NS vs. 10-mL suction (P < 0.0001). For the liver, a significant difference was found among suction pressures (P = 0.0079). Comparing “natural speed” with “whipping back” using the tenderloin, no significant difference in tissue yield was found with NS and 10 mL of pressure (P = 0.1126, P = 0.0718), but a significant difference was found with SP (P = 0.0028). Regarding the liver, no significant difference was found based upon suction pressure (NS P = 0.1508; SP P = 0.0873; 10 mL P = 0.6667).

Conclusions: EUS-FNAB using ProCore™ can be performed with negative pressure with any needling technique. Although ProCore™ has a reverse side-bevel, results in using it with a whipping-back technique were inconclusive.

• References

• 1 Wiersema MJ, Vilmann P, Giovannini M et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997; 112: 1087-1095
• 2 Siddiqui UD, Rossi F, Rosenthal LS et al. EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles. Gastrointest Endosc 2009; 70: 1093-1097
• 3 Nguyen TT, Lee CE, Whang CS et al. A Comparison of the diagnostic yield and specimen adequacy between 22 and 25 gauge needles for endoscopic ultrasound guided fine-needle aspiration (EUS–FNA) of solid pancreatic lesions (SPL): is larger better?. Gastrointest Endosc 2008; 67: AB100
• 4 Wakatsuki T, Irisawa A, Bhutani MS et al. Comparative study of diagnostic value of cytologic sampling by endoscopic ultrasonography-guided fine-needle aspiration and that by endoscopic retrograde pancreatography for the management of pancreatic mass without biliary stricture. J Gastroenterol Hepatol 2005; 20: 1707-1711
• 5 Iglesias-Garcia J, Poley JW, Larghi A et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
• 6 Iglesias-Garcia J, Abdulkader I, Souto R et al. Procore histology needles (19-gauge and 22 gauge) vs. standard cytology needles (22-gauge and 25-gauge) in the differential diagnosis of solid pancreatic tumors. Gastrointest Endosc 2011; 73: AB248
• 7 Bang JY, Hebert-Magee S, Trevino J et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
• 8 Iwashita T, Nakai Y, Samarasena JB et al. High single-pass diagnostic yield (cytology and histology) of a novel 25-gauge core biopsy needle for endoscopic ultrasound-guided fine needle aspiration and biopsy (EUS–FNAB) in pancreatic solid lesions. Gastrointest Endosc 2013; 77: 909-915
• 9 Nakai Y, Isayama H, Yamamoto N et al. A comparative study of suction technique vs. slow pull technique in EUS–FNA for pancreatic malignant lesions. Gastrointest Endosc 2014; 59: 1578-1585
• 10 Bang JY, Hebert-Magee S, Trevino J et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
• 11 Bhutani MS, Suryaprasad S, Moezzi J et al. Improved technique for performing endoscopic ultrasound guided fine needle aspiration of lymph nodes. Endoscopy 1999; 31: 550-553
• 12 Varadarajulu S, Fraig M, Schmulewitz N et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 2004; 36: 397-401
• 13 Levy MJ, Reddy RP, Wiersema MJ et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc 2005; 61: 467-472
• 14 Yang YJ, Damron TA. Comparison of needle core biopsy and fine-needle aspiration for diagnostic accuracy in musculoskeletal lesions. Arch Pathol Lab Med 2004; 128: 759-764
• 15 Varadarajulu S, Hasan MK, Bang JY et al. Endoscopic ultrasound-guided tissue acquisition. Dig Endosc 2014; 26: 62-69
• 16 Thomas T, Kaye PV, Ragunath K et al. Efficacy, safety, and predictive factors for a positive yield of EUS-guided Trucut biopsy: a large tertiary referral center experience. Am J Gastroenterol 2009; 104: 584-591
• 17 Larghi A, Verna EC, Stavropoulos SN et al. EUS-guided trucut needle biopsies in patients with solid pancreatic masses: a prospective study. Gastrointest Endosc 2004; 59: 185-190
• 18 Cho CM, Al-Haddad M, Leblanc JK et al. Rescue endoscopic ultrasound (EUS)-guided trucut biopsy following suboptimal EUS-guided fine needle aspiration for mediastinal lesions. Gut Liver 2013; 7: 150-156
• 19 Fabbri C, Luigiano C, Maimone A et al. Endoscopic ultrasound-guided fine-needle biopsy of small solid pancreatic lesions using a 22-gauge needle with side fenestration. Surg Endosc 2015; 29: 1586-1590
• 20 Witt BL, Adler DG, Hilden K et al. A comparative needle study: EUS-FNA procedures using the HD ProCore(TM and EchoTipTM)22-gauge needle types. Diagn Cytopathol 2013; 41: 1069-1074
• 21 Strand DS, Jeffus SK, Sauer BG et al. EUS-guided 22-gauge fine-needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms. Diagn Cytopathol 2014; 42: 751-758
• 22 Irisawa A, Hikichi T, Bhutani MS et al. Basic technique of FNA. Gastrointest Endosc 2009; 69: 125-129
• 23 Katanuma A, Itoi T, Baron TH et al. Bench-top testing of suction forces generated through endoscopic ultrasound-guided aspiration needles. J Hepatobiliary Pancreat Sci 2015; 22: 379-385