Download PDF
CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(01): 014-021
DOI: 10.1055/s-0042-1760276
Research Article

Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration with Fine-Needle Biopsy for Solid Gastrointestinal Lesions: A Randomized Crossover Single-Center study

Shivaraj Afzalpurkar 
1   Institute of Gastrosciences and Liver, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
,
Vijay Kumar Rai
1   Institute of Gastrosciences and Liver, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
,
Nikhil Sonthalia
1   Institute of Gastrosciences and Liver, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
,
Gajanan Rodge
1   Institute of Gastrosciences and Liver, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
,
Awanesh Tewary
1   Institute of Gastrosciences and Liver, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
,
Mahesh Goenka
1   Institute of Gastrosciences and Liver, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background/Aims The purpose of this study was to compare the results of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) and fine-needle biopsy (FNB) performed at the same site in a single session in the same patient.

Methods Consecutive patients with solid gastrointestinal lesions referred for EUS evaluation underwent EUS-FNA and FNB using 22G needles with three and two passes, respectively, in the same session. Patients were randomized to one group having EUS-FNA first followed by EUS-FNB, while other group had EUS-FNB first followed by EUS-FNA.

Results Total 50 patients (31 male) of mean age 56.58 ± 14.2 years and mean lesion size of 2.6 (±2) cm were included. The Kappa agreement for final diagnosis for FNA and FNB was 0.841 and 0.61, respectively. The sensitivity and specificity of FNA versus FNB were 85.19 versus 62.96% and 100 versus 100%, respectively, in comparison with final diagnosis.

Conclusion Both EUS-FNA and FNB are equally safe when compared between the two techniques simultaneously in same lesion. EUS-FNA is better than FNB in terms of sensitivity, diagnostic accuracy, and tissue yield for solid GI lesion. However, the specificity and positive predictive value were equally good for both the modalities.

Keywords

endoscopic ultrasound - fine-needle aspiration - fine-needle biopsy

Authors' Contributions

SA, MG, and VR helped in conceptualization and project administration. GR, SA, and AT contributed in data curation. NS and GR helped in formal analysis. VR and SA helped in investigation. MG, VR, and SA contributed to methodology. MG, VR, and SA helped in providing resources. VR and MG supervised the study. MG, VR, and GR helped in validation. MG and VR contributed to visualization. SA, MG, NS, and GR helped in review and editing. All the authors helped in writing-original draft.


* The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.




Publication History

Article published online:
13 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Kandel P, Wallace MB. Optimizing endoscopic ultrasound guided tissue sampling of the pancreas. JOP J Pancreas. 2016; 17: 160-165
    Search in Google Scholar
  • 2 Itoi T, Sofuni A, Itokawa F, Irisawa A, Khor CJ, Rerknimitr R. Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions. Dig Endosc 2011; 23 (Suppl. 01) 17-21
    CrossrefPubMedSearch in Google Scholar
  • 3 Dumonceau J-M, Polkowski M, Larghi A. et al; European Society of Gastrointestinal Endoscopy. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2011; 43 (10) 897-912
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Sepe PS, Moparty B, Pitman MB, Saltzman JR, Brugge WR. EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc 2009; 70 (02) 254-261
    CrossrefPubMedSearch in Google Scholar
  • 5 Song TJ, Kim JH, Lee SS. et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol 2010; 105 (08) 1739-1745
    CrossrefPubMedSearch in Google Scholar
  • 6 Ieni A, Todaro P, Crinò SF, Barresi V, Tuccari G. Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas: diagnostic efficacy of cell-block immunocytochemistry. Hepatobiliary Pancreat Dis Int 2015; 14 (03) 305-312
    CrossrefPubMedSearch in Google Scholar
  • 7 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 (03) 467-472
    CrossrefPubMedSearch in Google Scholar
  • 8 Gaddis GM, Gaddis ML. Introduction to biostatistics: Part 5, Statistical inference techniques for hypothesis testing with nonparametric data. Ann Emerg Med 1990; 19 (09) 1054-1059
    CrossrefPubMedSearch in Google Scholar
  • 9 Rao PS, Richard J. An Introduction to Biostatistics: A Manual for Students in Health Sciences. New Delhi: Prentice/Hall of India; 1996
    Search in Google Scholar
  • 10 Charan J, Biswas T. How to calculate sample size for different study designs in medical research?. Indian J Psychol Med 2013; 35 (02) 121-126
    CrossrefPubMedSearch in Google Scholar
  • 11 Elenbaas RM, Elenbaas JK, Cuddy PG. Evaluating the medical literature. Part II: Statistical analysis. Ann Emerg Med 1983; 12 (10) 610-620
    CrossrefPubMedSearch in Google Scholar
  • 12 Altonbary A, Hakim H, Bakr D, El-Shamy A, Elkashef W. Comparison of endoscopic ultrasound-guided tissue acquisition using 22 G versus 20 G procore needles in solid lesions: a pilot study. Egypt J Intern Med 2019; 31 (03) 266-272
    CrossrefSearch in Google Scholar
  • 13 Bang JY, Hebert-Magee S, Trevino J, Ramesh J, Varadarajulu S. 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 (02) 321-327
    CrossrefPubMedSearch in Google Scholar
  • 14 Alatawi A, Beuvon F, Grabar S. et al. Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United European Gastroenterol J 2015; 3 (04) 343-352
    CrossrefPubMedSearch in Google Scholar
  • 15 Khan MA, Grimm IS, Ali B. et al. A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment. Endosc Int Open 2017; 5 (05) E363-E375
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Karsenti D, Palazzo L, Perrot B. et al. 22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy. Endoscopy 2020; 52 (09) 747-753
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Asokkumar R, Yung Ka C, Loh T. et al. Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a randomized study. Endosc Int Open 2019; 7 (08) E955-E963
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Baek HW, Park MJ, Rhee Y-Y, Lee KB, Kim MA, Park IA. Diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology of pancreatic lesions. J Pathol Transl Med 2015; 49 (01) 52-60
    CrossrefPubMedSearch in Google Scholar
  • 19 Syed A, Babich O, Rao B. et al. Endoscopic ultrasound guided fine-needle aspiration vs core needle biopsy for solid pancreatic lesions: comparison of diagnostic accuracy and procedural efficiency. Diagn Cytopathol 2019; 47 (11) 1138-1144
    CrossrefPubMedSearch in Google Scholar
  • 20 Clarke DL, Clarke BA, Thomson SR, Garden OJ, Lazarus NG. The role of preoperative biopsy in pancreatic cancer. HPB (Oxford) 2004; 6 (03) 144-153
    CrossrefPubMedSearch in Google Scholar
  • 21 Vanbiervliet G, Napoléon B, Saint Paul MC. et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46 (12) 1063-1070
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Strand DS, Jeffus SK, Sauer BG, Wang AY, Stelow EB, Shami VM. EUS-guided 22-gauge fine-needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms. Diagn Cytopathol 2014; 42 (09) 751-758
    CrossrefPubMedSearch in Google Scholar
  • 23 Lee KH, Kim EY, Cho J. et al. Risk factors associated with adverse events during endoscopic ultrasound-guided tissue sampling. PLoS One 2017; 12 (12) e0189347
    CrossrefPubMedSearch in Google Scholar
  • 24 Hamada T, Yasunaga H, Nakai Y. et al. Severe bleeding and perforation are rare complications of endoscopic ultrasound-guided fine needle aspiration for pancreatic masses: an analysis of 3,090 patients from 212 hospitals. Gut Liver 2014; 8 (02) 215-218
    CrossrefPubMedSearch in Google Scholar