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

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.

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