Endoscopic ultrasound-guided tissue acquisition with or without macroscopic on-site evaluation: randomized controlled trial

Charing C. N. Chong; Sundeep Lakhtakia; Nam Nguyen; Kazuo Hara; Wah Kheong Chan; Rajesh Puri; Majid A. Almadi; Tiing Leong Ang; Andrew Kwek; Ichiro Yasuda; Shinpei Doi; Mitsuhiro Kida; Hsiu-Po Wang; Tsu-Yao Cheng; Qingwei Jiang; Aiming Yang; Anthony W. H. Chan; Shannon Chan; Raymond Tang; Takuji Iwashita; Anthony Y. B. Teoh

doi:10.1055/a-1172-6027

Endoscopy, Inhaltsverzeichnis

Endoscopy 2020; 52(10): 856-863
DOI: 10.1055/a-1172-6027

Original article

Endoscopic ultrasound-guided tissue acquisition with or without macroscopic on-site evaluation: randomized controlled trial

Charing C. N. Chong

¹Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

,

Sundeep Lakhtakia

²Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India

,

Nam Nguyen

³Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia

,

Kazuo Hara

⁴Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan

,

Wah Kheong Chan

⁵Department of Medicine, Faculty of Medicine, University of Malaya Medical Center, University of Malaya, Kuala Lumpur, Malaysia

,

Rajesh Puri

⁶Department of Gastroenterology and Hepatology, Medanta, The Medicity, Gurgaon, India

,

Majid A. Almadi

⁷Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia

,

Tiing Leong Ang

⁸Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore

,

Andrew Kwek

⁸Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore

,

Ichiro Yasuda

⁹Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan

,

Shinpei Doi

⁹Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan

,

Mitsuhiro Kida

¹⁰Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Japan

,

Hsiu-Po Wang

¹¹Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

,

Tsu-Yao Cheng

¹¹Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

,

Qingwei Jiang

¹²Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China

,

Aiming Yang

¹²Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China

,

Anthony W. H. Chan

¹³Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

,

Shannon Chan

¹Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

,

Raymond Tang

¹⁴Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

,

Takuji Iwashita

¹⁵First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

Anthony Y. B. Teoh

¹Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

› Institutsangaben

Abstract

Background The use of macroscopic on-site evaluation (MOSE) to estimate the adequacy of a specimen for histological diagnosis during endoscopic ultrasound (EUS)-guided fine-needle tissue acquisition (FNTA) has recently been advocated. This study aimed to evaluate the diagnostic yield of MOSE compared with conventional EUS-FNTA without rapid on-site evaluation (ROSE).

Methods This was an international, multicenter, prospective, randomized controlled study. After providing informed consent, consecutive adult patients referred for EUS-FNTA for solid lesions larger than 2 cm were randomized to a MOSE arm or to a conventional arm without ROSE. A designated cytopathologist from each center performed all cytopathological examinations for that center and was blinded to the randomization results. The primary outcome measure was the diagnostic yield, and the secondary outcomes included sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and the rate of procedure-related complications.

Results 244 patients (122 conventional, 122 MOSE) were enrolled during the study period. No significant differences between the two arms were found in procedure time or rate of procedure-related adverse events. The diagnostic yield for the MOSE technique (92.6 %) was similar to that for the conventional technique (89.3 %; P = 0.37), with significantly fewer passes made (median: conventional 3, MOSE 2; P < 0.001).

Conclusions EUS-FNTA with the MOSE technique provided a similar diagnostic yield to conventional EUS-FNTA technique in the absence of ROSE but with fewer passes. This technique can be used when ROSE is not available.

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Referenzen

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