Introduction
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle has a high diagnostic accuracy and enables physicians to obtain sufficient pathological samples compared to standard needles 1-2. However, no conclusion has been reached regarding the best combination of the number of passes and the number of to-and-fro movements (TAFs) in EUS-FNB. Although adverse events associated with EUS-FNB are rare, serious bleeding and tumor dissemination can occur 3.
Aims & Methods
Fewer passes and TAFs may help prevent these adverse events. Therefore, we conducted a prospective study to examine the diagnostic performance of a single pass with five TAFs in EUS-FNB. This single-center prospective observational study was conducted at a tertiary institution. From April 1, 2021, to August 31, 2022, 56 patients were enrolled. Three passes were performed using a 22-gauge Franseen needle (TopGainR; Medicos Hirata, Tokyo, Japan) during the EUS-FNB. The number of TAFs were 5 in the first passes (5-TAF group) and 15 in the second and third passes (15-TAF group), respectively. Each TAF was performed with a suction technique using a 20-mL negative pressure syringe. The primary endpoint was the accuracy of the first pass, and the secondary endpoint was a qualitative comparison of the specimens between the 5-TAF and 15-TAF groups. All patients were followed up for more than 6 months. Qualitative evaluation was performed as follows: the adequate sample score ranged from 0 to 5, and the contamination and bloodiness scores ranged from 0 to 3.
Results
A total of 56 patients were enrolled in this study. Of them, data from 53 patients were analyzed. Three patients were excluded: two patients had an insufficient number of passes due to bleeding during the procedure, and one patient could not be punctured due to difficulty in identifying the lesion. The patient characteristics were as follows: median age, 73 years (range, 48–92 years), number of male patients, 28 (52.8%). The final diagnoses were malignant disease in 42 patients and benign disease in 11. The accuracy rate was 86.7% (95% confidence interval: CI, 74.7–94.5%) in the 5-TAF group, 81.1% (95% CI, 72.4–88.1%) in the 15-TAF group; the total accuracy rate in the 5-TAF and 15-TAF groups was 89.3%. There was no significant difference in the accuracy rate between 2 groups. The adequacy scores (average [standard deviation]) of the 5-TAF and 15-TAF groups were 4 [1.45] and 3.39 [1.81], respectively. The rates of adequacy scores ≥3 in the 5-TAF and 15-TAF groups were 84.9% and 72.6%, respectively (p=0.09). The contamination scores of the 5-TAF and 15-TAF groups were 1.57 [1.01] and 1.91 [1.06], respectively. The rates of contamination scores ≤1 in the 5-TAF and 15-TAF groups were 51.9% and 34.6%, respectively (p<0.05). The bloodiness scores of the 5-TAF and 15-TAF groups were 0.57 [0.64] and 0.86 [0.79], respectively. The rates of bloodiness score ≤1 in the 5-TAF and 15-TAF groups were 92.3%, and 75.0%, respectively (p<0.05). For each score, the 5-TAF group had a higher value than the 15-TAF group.
Conclusion
In the EUS-FNB with a Franseen needle, a single pass with five TAFs showed the possibility of obtaining a clinically acceptable accuracy rate and high-quality specimens.
References
1) Ishigaki K, Nakai Y, Oyama H et al. Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions. Gut and Liver, 2020; 14(6): 817-825.
2) Li Z, Liu W, Xu X et al. A Meta-Analysis Comparing Endoscopic Ultrasound-guided Fine-needle Aspiration With Endoscopic Ultrasound-guided Fine-needle Biopsy. J Clin Gastroenterol 2022; 56(8): 668-678.
3) Mizuide M, Ryozawa S, Fujita A, et al. Complications of endoscopic ultrasound-guided fine needle aspiration: a narrative review. Diagnostics (Basel). 2020; 10: 964.
Disclosure
The authors have no conflicts of interest directly relevant to the content of this article.
