Twenty versus 40 back-and-forth needle movements for endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic masses: a prospective, crossover, randomized study

Eur J Gastroenterol Hepatol. 2023 Aug 1;35(8):836-842. doi: 10.1097/MEG.0000000000002579. Epub 2023 Jun 6.

Abstract

Background and aims: In endoscopic ultrasound (EUS)-fine-needle biopsy (FNB) of solid pancreatic mass lesions, the number of times the needle moves back and forth within the lesion might affect the collection of the sample and the subsequent diagnostic accuracy. Thus, this study was designed to compare the diagnostic adequacy between different numbers of back-and-forth movements in EUS-FNB.

Methods: Fifty-five patients with solid pancreatic masses underwent EUS-FNB sampling with the needle (22-gauge) moved 20 times (MTT) and 40 times (MFT) randomly and sequentially for a total of four alternating passes. We compared the acquisition rate of appropriate and adequate specimens for histologic assessment and diagnostic accuracy.

Results: Finally, 55 patients (35 men and 20 women) were included in the study. We found that 56.4% (31/55) and 60% (33/55) of the specimens obtained using MTT and MFT, respectively, could be adequately diagnosed histologically (P = 0.815, McNemar test). The diagnostic accuracy of MTT and MFT was 72.7% (40/55) and 80% (44/55), respectively (P = 0.289, McNemar test). The overall diagnostic accuracy was 89.1%.

Conclusion: There was no significant statistical difference between the histopathological diagnostic samples obtained in MTT and those obtained in MFT. Therefore, a large number of back-and-forth movements of the needle should be avoided during EUS-FNB, which can help reduce the operation time and may reduce the risk of intraoperative and postoperative complications (Clinical trial registration number: ChiCTR2000031106).

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Endoscopic Ultrasound-Guided Fine Needle Aspiration*
  • Endoscopy
  • Endosonography
  • Female
  • Humans
  • Image-Guided Biopsy
  • Male
  • Pancreas / diagnostic imaging
  • Pancreas / pathology
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / pathology
  • Prospective Studies