Endoscopy 2001; 33(6): 484-490
DOI: 10.1055/s-2001-14970
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Focal Pancreatic Lesions: A Prospective Intraindividual Comparison of Two Needle Assemblies

A. Fritscher-Ravens1 , T. Topalidis2 , C. Bobrowski3 , C. Krause1 , F. Thonke1 , S. Jäckle1 , N. Soehendra1
  • 1 Dept. of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany
  • 2 Institute of Cytopathology, Hannover, Germany
  • 3 Dept. of Internal Medicine, University Hospital Eppendorf, Hamburg, Germany
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Background and Study Aims: The results of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in focal pancreatic lesions are less impressive than those in the mediastinum. The aim of this prospectively randomized study was to compare two commercially available needle assemblies with regard to handling and cytopathological yield.

Patients and Methods: A total of 30 patients (19 men, 11 women; mean age 61) with focal pancreatic lesions underwent EUS-FNA with each of the two needles (GIP, Wilson-Cook). The sequence was randomized for the examiner and blinded for the cytologist. Three patients had to be excluded because of the impossibility of sample assignment or patient follow-up. EUS-FNA was performed using the standard technique with linear echo endoscopes.

Results: None of the characteristics evaluated by the examiner differed significantly between either of the needles. Inadequate results were obtained in 11 % using the GIP needle, but in none with the Wilson-Cook needle. GIP needle cytology revealed malignancy in 11 patients (sensitivity, specificity, and accuracy were 55 %, 100 %, and 65 %, respectively, including inadequate results). The aspirates obtained with the Wilson-Cook needle identified malignancy in 16 patients (sensitivity, specificity, and accuracy were 85 %, 100 %, and 89 %, respectively).

Conclusions: No statistically significant differences were detected in the handling of either of the two needle assemblies. No complications were reported using the GIP needles. However, in four procedures breakages of the outer Teflon sheath of the Wilson-Cook needle occurred, and in another four cases re-insertion of the stylet was impossible. Nevertheless, cytopathologic results were significantly better with the Wilson-Cook needle.

References

  • 1 Erickson R A, Sayage-Rabie L, Beissner S. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies.  Gastrointest Endosc. 2000;  51 184-190
  • 2 Frazee R C, Singh H, Erickson R A. Endoscopic ultrasound for peripancreatic masses.  Am J Surg. 1997;  174 596-599
  • 3 Tao L C, Ho C S, McLoughlin M J. Percutaneous fine-needle aspiration biopsy of the pancreas: cytodiagnosis of pancreatic carcinoma.  Acta Cytol. 1978;  22 215-220
  • 4 Cahn M, Chang K, Nguyen P, et al. Impact of endoscopic ultrasound with fine-needle aspiration on the surgical management of pancreatic cancer.  Am J Surg. 1996;  172 470-472
  • 5 Fritscher-Ravens A, Izbicki J, Sri Ram P VJ, et al. Endosonography-guided aspiration cytology extending the indication for organ-preserving pancreatic surgery.  Am J Gastroenterol. 2000;  95 2255-2260
  • 6 Williams D B, Sahai A V, Aabakken L, et al. Endoscopic ultrasound guided fine-needle aspiration biopsy: a large single-center experience.  Gut. 1999;  44 720-726
  • 7 Gress F, Savides T, Sandler A, et al. Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer: a comparison study.  Ann Intern Med. 1997;  127 604-612
  • 8 Silvestri G A, Hoffmann B J, Bhutani M S, et al. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer.  Ann Thorac Surg. 1996;  61 1441-1446
  • 9 Fritscher-Ravens A, Soehendra N, Schirrow L, et al. Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer.  Chest. 2000;  117 339-345
  • 10 Wiersema M J, Vilmann P, Giovannini M, et al. Endosonographic guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
  • 11 Giovannini M, Seitz J F, Monges G, et al. Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
  • 12 Bhutani M S, Hawes R H, Baron P L, et al. Endoscopic ultrasound-guided fine-needle aspiration of malignant pancreatic lesions.  Endoscopy. 1997;  29 854-858
  • 13 Chang K J, Nguyen P, Erickson R A. The clinical utility of endoscopic ultrasound guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma.  Gastrointest Endosc. 1997;  45 387-393
  • 14 Erickson R A, Sayage-Rabie L, Avots-Avotins A. Clinical utility of endoscopic ultrasound-guided fine needle aspiration.  Acta Cytol. 1997;  41 1647-1653
  • 15 Faigel D, Ginsberg G, Bentz J, et al. Endoscopic ultrasound guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions.  J Clin Oncol. 1997;  15 1439-1443
  • 16 Gress F G, Hawes R H, Savides T J, et al.. Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography.  Gastrointest Endosc. 1997;  45 243-250
  • 17 Bentz J S, Kochman M L, Faigel D O, et al. Endoscopic ultrasound-guided real-time fine-needle aspiration: clinicopathologic features of 60 patients.  Diagn Cytopathol. 1998;  18 98-109
  • 18 Suits J, Frazee R, Erickson R A. Endoscopic ultrasound and fine needle aspiration for the evaluation of pancreatic masses.  Arch Surg. 1999;  134 639-643
  • 19 Voss M, Hammel P, Molas G, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses.  Gut. 2000;  46 244-249
  • 20 Vilmann P, Hancke S, Henriksen F W, et al. Endoscopic ultrasonography with guided fine-needle aspiration biopsy of malignant lesions in the upper gastrointestinal tract.  Endoscopy. 1993;  25 523-527
  • 21 Binmöller K F, Thul R, Rathod V, et al. Endoscopic ultrasound-guided, 18 gauge, fine-needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope.  Gastrointest Endosc. 1998;  47 121-127
  • 22 Bhutani M S, Suryaprasad S, Moezzi J, et al. Improved technique for performing endoscopic ultrasound guided fine needle aspiration of lymph nodes.  Endoscopy. 1999;  31 550-553
  • 23 Atay Z. The reliability of cytodiagnosis in determining malignancy histogenetic tumor type. In: Nakhosteen JA, Maassen W (eds). Bronchology: research, diagnostic and therapeutic aspects. Boston; Nijhoff 1981: 37-42
  • 24 O’Malley M E, Boland G W, Wood G W, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin section pancreatic phase helical CT.  AJR Am J Roentgenol. 1999;  173 1513-1518
  • 25 Howard T J, Chin A C, Streib E W, et al. Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma.  Am J Surg. 1997;  174 237-241
  • 26 Vilmann P. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes.  Gastrointest Endosc. 1996;  43 S24-S29
  • 27 Fritscher-Ravens A, Sriram P VJ, Krause C, et al. Detection of pancreatic metastases by EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 65-70
  • 28 Tio T L. EUS-guided FNA: a few caveats.  Gastrointest Endosc. 1998;  47 421-422
  • 29 Vilmann P. Endoscopic ultrasonography.  . Copenhagen; Munksgaard 1998: 108-115
  • 30 Yasuda K, Uno M, Tanaka K, et al. EUS-guided fine aspiration biopsy (FNA): indications and hazards.  Endoscopy. 1998;  30 A 163-165
  • 31 Schembre D B, Jiranek G C, Hogan S F. Prospective comparison of 22 gauge versus 19 gauge needle for endoscopic ultrasound directed fine needle aspiration of pancreatic masses: does size matter (abstract)?.  Gastrointest Endosc. 2000;  51 (2) AB 161
  • 32 Mostbeck G H, Wittich G R, Derfler K, et al. Optimal needle size for renal biopsy: in vitro and in vivo evaluation.  Radiology. 1989;  173 819-822
  • 33 Lübbers H, Mahlke R, Haake C, Lankisch P G. A new fine needle for easier, single handed, ultrasound guided biopsies, requiring less advancing forces into solid organs.  Z Gastroenterol. 1993;  31 484-485
  • 34 Binmöller K F, Brand B, Thul R, et al. EUS-guided, fine-needle aspiration biopsy using a new mechanical scanning puncture echoendoscope.  Gastrointest Endosc. 1998;  47 335-340
  • 35 Gupta R K. Value of image guided fine needle aspiration cytology in the diagnosis of pancreatic malignancies.  Diagn Cytopathol. 1995;  13 120-123

 A. Fritscher-Ravens, M.D.

Dept. of Interdisciplinary Endoscopy
University Hospital, Eppendorf

Martinistrasse 52
20246 Hamburg
Germany


Fax: Fax:+ 49-40-428034420

Email: E-mail:FRI-RAV@t-online.de