Introduction
There is no unanimity regarding the most appropriate needle to use for endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). To date, new types of FNB needles have been designed, including the Fork-tip and Franseen needles. The Fork-tip is characterized by two sharp tips on opposite sides of the lumen, and the Franseen needles are characterized by three symmetric cutting tips. This study primarily aimed to compare the diagnostic utility and histological quality between the use of the Fork-tip and Franseen neesles in EUS-FNB for solid pancreatic lesions.
Aims & Methods
We retrospectively analyzed 187 patients at our center for solid pancreatic lesions, 75 of whom underwent EUS-FNB using a 22 G Franseen needle and 112 using a 22 G Fork-tip needle, from December 2019 to October 2022.
Results
After propensity-matched analysis, each group was adjusted to 66 cases. The results revealed that sex, age, route for puncture, and tumor size, site, and tumor type were not different between the Franseen and Fork-tip groups. Both groups were not significantly different in terms of number of punctures, procedure time, core tissue score, blood score, and technical success rate. From the histological findings, the most common final diagnosis was adenocarcinoma (107 patients), which was followed by a benign lesion (19 patients), and finally, the NET (6 patients). In this study, no adverse events during the procedure were encountered. The diagnostic accuracy of the Fork-tip group (92.4%; 61/66) was similar to that of the Franseen group (90.9%; 60/66) (P >0.99). The outcomes of the two groups were similar for the distinction between benign and malignant lesions. The rate of changes of operators from a trainee was significantly less in the Fork-tip group (9.1%, 6/66) than in the Franseen group (24.2%, 16/66) (P = 0.03). The reasons for operator changes were as follows: In the Franseen group, there were ten cases of difficulty in adjusting the puncture route from the second part of the duodenum, six cases of difficulty in penetrating the gastric wall from the stomach. In contrast, in the Fork-tip group, there were two cases of difficulty in adjusting the puncture route from the second part of the duodenum, two cases of difficulty in penetrating the gastric wall from the stomach, two cases of difficulty in avoiding vessels. All cases were successfully punctured after an expert took over.
| Propensity-matched patients
|
| Franseen group
| Fork-tip group
| P
|
Number of punctures, median (IQR)
| 2 (2–2)
| 2 (2–2)
| 0.85
|
Change from trainee to expert
| 16/66 (24.2%)
| 6/66 (9.1%)
| 0.03
|
Diagnostic accuracy, n (%)
| 60/66 (90.9%)
| 61/66 (92.4%)
| >0.99
|
Sensitivity
| 89.3% (50/56)
| 91.2% (52/57)
| 0.76
|
Specificity
| 100% (10/10)
| 100% (9/9)
|
|
Positive predictive value
| 100% (50/50)
| 100% (52/52)
|
|
Negative predictive value
| 62.5% (10/16)
| 64.3% (9/14)
|
|
Table 1. Comparison of procedure outcome and histological material between Franseen and Fork-tip groups
Conclusion
Although in both groups, the diagnostic accuracy and other outcomes of procedures conducted, were not significantly different, the rate of changes of operator from a trainee to an expert was significantly less in the Fork-tip group than in the Franseen group. Thus, the Fork-tip needle was observed as good choice for trainees and the appropriate needle must be selected according to the situation.