Slow-Pull Using a Fanning Technique Is More Useful Than the Standard Suction Technique in EUS-Guided Fine Needle Aspiration in Pancreatic Masses
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for obtaining pancreatic mass samples. The combination of modified techniques (i.e., slow-pull technique and fanning technique) may improve the quality of the sample obtained by EUS-FNA. We investigated the effectiveness of a combined slow-pull fanning technique in EUS-FNA for pancreatic mass. Methods: This prospective comparative study investigated EUS-FNA performed for pancreatic solid masses between August 2015 and July 2016. Pairwise specimens were alternately obtained using the following two techniques for targeted pancreatic lesions: standard suction or slow-pull with fanning. We compared the specimen quality, blood contamination, and diagnostic accuracy of these techniques. Results: Forty-eight consecutive patients were included (29 men; mean age, 68.1±11.9 years), and 96 pancreatic mass specimens were obtained. The slow-pull with fanning technique had a significantly superior diagnostic accuracy than the suction technique (88% vs 71%, p=0.044). Furthermore, blood contamination was significantly reduced using the slow-pull with fanning technique (ratio of no or slight contamination, 77% vs 56%, p=0.041). No difference was observed in the acquisition of adequate cellularity between the groups. In the subgroup analysis, the tumor size and sampling technique were related to the EUSFNA diagnostic accuracy. Conclusions: The slow-pull with needle fanning technique showed a good diagnostic yield for EUS-FNA for pancreatic mass. This technique can be useful for performing EUS-guided sampling for diagnosing pancreatic disease.
Abstract
Background/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for obtaining pancreatic mass samples. The combination of modified techniques (i.e., slow-pull technique and fanning technique) may improve the quality of the sample obtained by EUS-FNA. We investigated the effectiveness of a combined slow-pull fanning technique in EUS-FNA for pancreatic mass. Methods: This prospective comparative study investigated EUS-FNA performed for pancreatic solid masses between August 2015 and July 2016. Pairwise specimens were alternately obtained using the following two techniques for targeted pancreatic lesions: standard suction or slow-pull with fanning. We compared the specimen quality, blood contamination, and diagnostic accuracy of these techniques. Results: Forty-eight consecutive patients were included (29 men; mean age, 68.1±11.9 years), and 96 pancreatic mass specimens were obtained. The slow-pull with fanning technique had a significantly superior diagnostic accuracy than the suction technique (88% vs 71%, p=0.044). Furthermore, blood contamination was significantly reduced using the slow-pull with fanning technique (ratio of no or slight contamination, 77% vs 56%, p=0.041). No difference was observed in the acquisition of adequate cellularity between the groups. In the subgroup analysis, the tumor size and sampling technique were related to the EUSFNA diagnostic accuracy. Conclusions: The slow-pull with needle fanning technique showed a good diagnostic yield for EUS-FNA for pancreatic mass. This technique can be useful for performing EUS-guided sampling for diagnosing pancreatic disease.
참고문헌 (29)
- Hewitt MJ, "EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis", Gastrointest Endosc, 75, pp.319~331 (2012)[DOI]
- Itoi T, "Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions", Dig Endosc, 23(Suppl 1), pp.17~21 (2011)
- Puli SR, "How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass? A metaanalysis and systematic review", Pancreas, 42, pp.20~26 (2013)[DOI]
- Chang Yun Hwang, "Endoscopic Ultrasound Guided Fine Needle Aspiration Biopsy in Diagnosis of Pancreatic and Peripancreatic Lesions: A Single Center Experience in Korea", Gut and Liver, 3(2), pp.116~121 (2009), 거트앤리버 소화기연관학회협의회
- Affolter KE, "Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: a systematic review and meta-analysis", Dig Dis Sci, 58, pp.1026~1034 (2013)[DOI]
- Chen J, "Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesion: a systematic review", J Cancer Res Clin Oncol, 138, pp.1433~1441 (2012)[DOI]
- Chen JY, "Slow-pull and different conventional suction techniques in endoscopic ultrasound-guided fineneedle aspiration of pancreatic solid lesions using 22-gauge needles", World J Gastroenterol, 22, pp.8790~8797 (2016)[DOI]
- Bang JY, "Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions", Endoscopy, 45, pp.445~450 (2013)[DOI]
- Nakai Y, "Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses", Dig Dis Sci, 59, pp.1578~1585 (2014)[DOI]
- Paik WH, "Prospective evaluation of new 22 gauge endoscopic ultrasound core needle using capillary sampling with stylet slow-pull technique for intra-abdominal solid masses", J Clin Gastroenterol, 49, pp.199~205 (2015)[DOI]
- Turner BG, "Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy", Gastrointest Endosc, 71, pp.91~98 (2010)[DOI]
- Ryozawa S, "Usefulness of endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of pancreatic cancer", J Gastroenterol, 40, pp.907~911 (2005)[DOI]
- Weston BR, "Optimizing diagnostic yield for EUSguided sampling of solid pancreatic lesions: a technical review", Gastroenterol Hepatol (N Y), 9, pp.352~363 (2013)
- Vilmann P, "Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease", Gastrointest Endosc, 38, pp.172~173 (1992)[DOI]
- Dumonceau JM, "Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline", Endoscopy, 43, pp.897~912 (2011)[DOI]
- Itoi T, "Experimental endoscopy: objective evaluation of EUS needles", Gastrointest Endosc, 69(3), pp.509~516 (2009)[DOI]
- Yusuf TE, "Retrospective analysis of the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic masses, using a 22-gauge or 25-gauge needle system: a multicenter experience", Endoscopy, 41, pp.445~448 (2009)[DOI]
- Song TJ, "The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses", Am J Gastroenterol, 105, pp.1739~1745 (2010)[DOI]
- Madhoun MF, "The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasoundguided fine needle aspiration of solid pancreatic lesions: a metaanalysis", Endoscopy, 45, pp.86~92 (2013)[DOI]
- Iwashita T, "High single-pass diagnostic yield of a new 25-gauge core biopsy needle for EUSguided FNA biopsy in solid pancreatic lesions", Gastrointest Endosc, 77, pp.909~915 (2013)[DOI]
- Tadahisa Inoue, "Assessment of Factors Affecting the Usefulness and Diagnostic Yield of Core Biopsy Needles with a Side Hole in Endoscopic Ultrasound-Guided Fine-Needle Aspiration", Gut and Liver, 10(1), pp.51~57 (2016), 거트앤리버 소화기연관학회협의회
- 방지영, "Procore and Flexible 19 Gauge Needle Can Replace Trucut Biopsy Needle?", Clinical Endoscopy, 46(5), pp.503~505 (2013), 대한소화기내시경학회
- Yasuda I, "Tips for endoscopic ultrasound-guided fine needle aspiration of various pancreatic lesions", J Hepatobiliary Pancreat Sci, 21, pp.E29~E33 (2014)[DOI]
- Kundu S, "Suction or no suction? Interval results from an ongoing prospective, partially blinded, randomized trial of endoscopic ultrasound (EUS) guided fine needle sampling of solid lesions", Gastrointest Endosc, 69, pp.S248~S249 (2009)
- Puri R, "Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis", Scand J Gastroenterol, 44, pp.499~504 (2009)[DOI]
- Sahai AV, "A prospective comparison of endoscopic ultrasound-guided fine needle aspiration results obtained in the same lesion, with and without the needle stylet", Endoscopy, 42, pp.900~903 (2010)[DOI]
- Rastogi A, "A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet", Gastrointest Endosc, 74, pp.58~64 (2011)[DOI]
- Iglesias-Garcia J, "Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses", Am J Gastroenterol, 106, pp.1705~1710 (2011)[DOI]
- Kin T, "Diagnostic ability of EUS-FNA for pancreatic solid lesions with conventional 22-gauge needle using the slow pull technique: a prospective study", Scand J Gastroenterol, 50, pp.900~907 (2015)[DOI]