Puncture of Solid Pancreatic Tumors Guided by Endoscopic Ultrasonography: A Pilot Study Series Comparing Trucut and 19-Gauge and 22-Gauge Aspiration Needles
T. Itoi1
, F. Itokawa1
, A. Sofuni1
, K. Nakamura1
, A. Tsuchida2
, K. Yamao3
, T. Kawai4
, F. Moriyasu1
1Fourth Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
2Third Department of Surgery, Tokyo Medical University, Tokyo, Japan
3Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
4Endoscopic Center, Tokyo Medical University, Tokyo, Japan
Background and Study Aims: The aim of this prospective study was to compare endoscopic ultrasonography-guided Trucut needle biopsy (EUS-TNB) with EUS-guided fine-needle aspiration biopsy (EUS-FNAB) using 19- and 22-gauge needles for biopsy from different sites in patients with solid pancreatic cancers. Patients and Methods: Sixteen consecutive patients with masses in the uncinate process (n = 3), the head (n = 5), or the body and tail (n = 8) of the pancreas underwent both EUS-TNB and EUS-FNAB. The specimens obtained were evaluated by histopathological analysis alone Results: Tissue specimens were obtained by Trucut needle, and by 19-gauge and 22-gauge aspiration needles in 69 %, 69 %, and 100 % of patients respectively. Sensitivity for malignancy was 69 % for all needles. Tissue sampling by Trucut and by 19-gauge aspiration needle from masses in the uncinate process was impossible. The sensitivity of the Trucut and 19-gauge aspiration needles was 100 % in the 11 patients with successful procedures. If Trucut or19-gauge aspiration needles had been used for body and tail masses, and the 22-gauge aspiration needle for masses in the uncinate process and head, the sensitivity for malignancy would have been 81 %. Conclusions: EUS-TNB allows reliable tissue sampling for the diagnosis of pancreatic masses, but its use is limited to lesions in the body and tail of the pancreas. EUS-FNAB using a 22-gauge needle may be useful for accurate diagnosis in some patients with masses in the uncinate process or the head of the pancreas.
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