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Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses.

Author(s): Nakai Y, Isayama H, Chang KJ, Yamamoto N, Hamada T, Uchino R, Mizuno S, Miyabayashi K, Yamamoto K, Kawakubo K, Kogure H, Sasaki T, Hirano K, Tanaka M, Tada M, Fukayama M, Koike K

Publication: Dig Dis Sci, 2014, Vol. 59, Page 1578-85

PubMed ID: 24429514 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The study compared the effects of slow-pull versus suction and needle gauge size in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions. Ninety-three patients with suspected pancreatic malignant solid masses underwent biopsy during which the stylet was removed and the needle moved to-and-fro 10-20 times with 10-20 cc suction applied (suction technique) or the needle was moved to-and-fro 10-20 times while slowly and continuously pulling the stylet (slow-pull technique) with either a 22-gauge or 25-gauge needle. Cellularity (0=no cellularity, 1=few cellular aggregates, 2=fair cellularity, 3=abundant cellularity) and blood contamination scores (0=none, 1=few, 2=moderate, 3=high) were determined by cytologic examination of each specimen by two cytotechnologists. Formalin-fixed samples were used for histologic examination and the pathologic diagnosis was determined by a combination of cytological and histological evaluation.

   Summary of Findings:

   Overall, the slow-pull technique demonstrated better diagnostic accuracy and sensitivity than suction (P = 0.039 and P = 0.025, respectively) and resulted in fewer specimens with moderate or high levels of blood contamination (50.1% versus 60.8%, respectively P = 0.074); however, 71.8% of specimens obtained with the suction method had a cellularity score of ≥ 2 (fairly or abundantly cellular) compared to only 52.2% of specimens obtained with the slow-pull technique (P < 0.001). No statistical difference between the slow-pull and suction techniques was observed in diagnostic yield, cellularity, or blood contamination when only the specimens obtained with a 22-gauge needle were considered, but specimens obtained with a 25-gauge needle by the slow-pull technique rather than the suction technique resulted in more specimens with a cellularity score ≥ 2 (p<0.001),  fewer specimens with moderate or high levels of blood contamination (P < 0.001)  and increased diagnostic accuracy (91.1% versus 70%, P = 0.001), sensitivity (90.0 versus 67.9%, P = 0.003), and negative predictive value (54.5 versus 18.2%, P = 0.045). The sensitivity of cytological assessment was comparable between specimens obtained by slow-pull and suction (67.3% versus 67.5%, P = 1.00) but the sensitivity of histological assessment was better for the slow-pull technique than the suction technique (90% versus 73.1%, P = 0.012); resulting in a statistically significant higher diagnostic sensitivity for the combination of cytology and histology in specimens obtained with the slow-pull technique (82.5% versus 71.9%, P = 0.026). However, the effect of acquisition technique on the diagnostic sensitivity of the combined cytological and histological analysis was only observed for specimens obtained with a 25-gauge needle (p=0.003), but not a 22-gauge needle. Increased sensitivity by EUS-FNA was associated with slow-pull technique (P = 0.028), tumor size ≥25 mm (P < 0.001), and tumor location in the pancreas body or tail (P < 0.001) and that the use of a 25-gauge needle rather than 22-gauge resulted in a non-significantly greater sensitivity (P = 0.137).

   Biospecimens

   • Tissue - Pancreas

   Preservative Types

   • Formalin

   Diagnoses:

   • Neoplastic - Carcinoma

   Platform:

   Analyte	Technology Platform
   Morphology	Light microscopy
   Cell count/volume	Light microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Preaquisition	Diagnosis/ patient condition	Tumor size <25mm Tumor size ≥25mm
   Biospecimen Acquisition	Needle gauge	22-gauge 25-gauge
   Biospecimen Acquisition	Method of tissue acquisition	Ultrasound-guided fine needle aspiration
   Biospecimen Acquisition	Biospecimen location	Pancreas head Pancreas body Pancreas tail

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