Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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A comparative study of endoscopic ultrasound guided fine needle aspiration with and without a stylet.

Author(s): Wani S, Gupta N, Gaddam S, Singh V, Ulusarac O, Romanas M, Bansal A, Sharma P, Olyaee MS, Rastogi A

Publication: Dig Dis Sci, 2011, Vol. 56, Page 2409-14

PubMed ID: 21327919 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study investigated the effects of using a stylet during EUS-FNA on cytological quality and diagnostic accuracy and compared the diagnostic accuracy of pancreas and lymph node biopsies. Between January 2006 and October 2007, 72 patients with 106 solid lesions (pancreatic mass, liver mass, left adrenal mass, gastrointestinal submucosal lesions, lymph nodes, or mediastinal mass) underwent EUS-FNA using a 22G needle with a stylet. Between October 2007 and July 2009, 90 additional patients with 122 solid lesions underwent the same EUS-FNA procedure by the same endosonographers but without the use of a stylet. Slides were stained with DiffQuik and Papanicolau and cytospin cell blocks were placed in Saccomano or Cytolyte.  One of 2 cytopathologists blinded to stylet use evaluated each case for cellularity, gastrointestinal contamination, blood contamination, and specimen adequacy and assigned a cytological diagnosis. Scores for cellularity and gastrointestinal contamination were based on the percentage of the slide area with representative cells or contamination (0 if 0%, 1 if <25%, 2 if 25-50%, or 3 if >50%). Amount of blood was scored as 1 if minimal, 2 if moderate, and 3 if significant. Overall specimens were scored as 0 if inadequate and 1 if adequate. Diagnosis was based on final surgical pathology or follow-up clinical and radiological results.

   Summary of Findings:

   Use of a stylet did not affect cellularity, gastrointestinal contamination, specimen adequacy or the end cytologic diagnosis. However, EUS-FNA conducted with the stylet resulted in significantly fewer specimens with minimal blood contamination than when a stylet was not used (18.9% versus 7.4%, p=0.02) and fewer specimens had moderate or significant blood contamination when obtained with a stylet than obtained without, but the differences were not significant. When malignant lesions were biopsied, they were identified as malignant at comparable rates, regardless of stylet usage (71% with stylet and 74% without). Further, the identification of malignancy was still comparable regardless of stylet used if suspicious lesions were classified as malignant (81% with stylet and 77.5% without). The diagnostic accuracy for malignancy of EUS-FNA was 85.7% for pancreatic lesions but 62.7% for lymph nodes and increased to 96.4% for pancreatic lesions and 70.5% for lymph nodes with inclusion of cytologically suspicious lesions in the malignant category. 

   Biospecimens

   • Cell - Pancreas
   • Cell - Liver
   • Cell - Small Bowel
   • Cell - Adrenal Gland
   • Cell - Stomach
   • Cell - Lymph Node

   Preservative Types

   • Other Preservative

   Diagnoses:

   • Neoplastic - Carcinoma
   • Neoplastic - Not specified
   • Neoplastic - Benign

   Platform:

   Analyte	Technology Platform
   Morphology	Light microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Biospecimen location	Pancreas Lymph node
   Biospecimen Acquisition	Method of cell acquisition	EUS-FNA with stylet EUS-FNA without stylet

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