Retrospective analysis of the use of 22-gauge and 25-gauge needles for EUS-guided fine needle aspiration of solid lesions



EUS-FNA, cytopathology, 22-gauge needle, 25-gauge needle


Background/Aim: Data on the comparison of diagnostic yields of 22-gauge (22G) and 25-gauge (25G) needles used in endoscopic ultrasound guided fine needle aspiration (EUS-FNA) biopsy usually include solid pancreatic masses. In our study, we compared the diagnostic yield, safety, and performance characteristics of 22G and 25G needles in the EUS-FNA of various solid lesions in or adjacent to the upper gastrointestinal wall and suspicious lymph nodes. Methods: In this retrospective cohort study, we enrolled patients who underwent EUS-FNA using 22G and 25G needles between August 2018 and January 2020. We compared EUS-FNA results with histological findings in operated patients and long-term clinical follow-up results in non-operated patients. Results: Seventy-nine patients (40 patients with 22G needles) were enrolled. There were pancreatic solid masses in 50 (63.3%) patients, subepithelial lesions in 13 (16.5%), suspicious lymph nodes in 12 (15.2%), and various lesions adjacent to the lumen in 4 (5.1%) patients. The diagnostic yield of 22G and 25G needles were 92.5% and 94.9%, respectively, which were similar (P=0.664). EUS-FNA of 2 pancreatic masses required a crossover from a 22G needle to a 25G needle due to lesion stiffness. The technical success rate for the lesion type was 100% and 95% for 25G and 22G needles, respectively (P=0.160). No major complications were observed with either needle. Conclusions: The 25G needle was not superior to the 22G needle in terms of diagnostic yield and safety profile in EUS-FNA of solid lesions. The use of 25G needles in hard masses can provide ease of puncture.


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Yamao K, Sawaki A, Mizuno N, Shimizu Y, Yatabe Y, Koshikawa T. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future. J Gastroenterol. 2005;40(11):1013-23. doi: 10.1007/s00535-005-1717-6

Camellini L, Carlinfante G, Azzolini F, Iori V, Cavina M, Sereni G, et al. A randomized clinical trial comparing 22G and 25G needles in endoscopic ultrasound-guided fine-needle aspiration of solid lesions. Endoscopy. 2011;43(8):709-15. doi: 10.1055/s-0030-1256482.

Fabbri C, Polifemo AM, Luigiano C, Cennamo V, Baccarini P, Collina G, et al. Endoscopic ultrasound-guided fine needle aspiration with 22- and 25-gauge needles in solid pancreatic masses: a prospective comparative study with randomisation of needle sequence. Dig Liver Dis. 2011;43(8):647-52. doi: 10.1016/j.dld.2011.04.005.

Vilmann P, SĂftoiu A, Hollerbach S, Guldhammer Skov B, Linnemann D, Popescu CF, et al. Multicenter randomized controlled trial comparing the performance of 22 gauge versus 25gauge EUS-FNA needles in solid masses. Scand J Gastroenterol. 2013;48(7):877-83. doi: 10.3109/00365521.2013.799222.

Affi A, Vazquez-Sequeiros E, Norton ID, Clain JE, Wiersema MJ. Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance. Gastrointest Endosc. 2001;53(2):221-25. doi: 10.1067/mge.2001.111391.

Affolter KE, Schmidt RL, Matynia AP, Adler DG, Factor RE. Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: a systematic review and meta-analysis. Dig Dis Sci. 2013;58(4):1026-34. doi: 10.1007/s10620-012-2439-2.

Guedes HG, Hourneaux de Moura DT, Duarte RB, Coronel Cordero MA, Lera Dos Santos ME, Cheng S, et al. A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis. Clinics. 2018;73: e261. doi: 10.6061/clinics/2018/e261.

Alper E, Onur I, Arabul M, Unsal B. Endoscopic ultrasound-guided tissue sampling: How can we improve the results? Turk J Gastroenterol. 2016;27(1):1-3. doi: 10.5152/tjg.2015.150497.

Siddique DA, Rahal MA, Trevino K, Wu HH, Al-Haddad MA. Endoscopic ultrasound-guided sampling of solid pancreatic lesions: A comparative analysis of 25 gauge versus 22 gauge core biopsy needles. Anticancer Res. 2020;40(10):5845-51. doi: 10.21873/anticanres.14603.

Lee JK, Lee KT, Choi ER, Jang TH, Jang KT, Lee JK, et al. A prospective, randomized trial comparing 25-gauge and 22-gauge needles for endoscopic ultrasound-guided fine needle aspiration of pancreatic masses. Scand J Gastroenterol. 2013;48(6):752-57. doi: 10.3109/00365521.2013.786127.

Sakamoto H, Kitano M, Komaki T, Noda K, Chikugo T, Dote K, et al. Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol. 2009;24(3):384-90. doi: 10.1111/j.1440-1746.2008.05636.x

Yusuf TE, Ho S, Pavey DA, Michael H, Gress FG. 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. 2009;41(5):445-48. doi: 10.1055/s-0029-1214643.

Polkowski M, Bergman JJ. Endoscopic ultrasonography-guided biopsy for submucosal tumors: needless needling? Endoscopy. 2010;42(4):324-26. doi: 10.1055/s-0029-1244070.

Philipper M, Hollerbach S, Gabbert HE, Heikaus S, Böcking A, Pomjanski N, et al. Prospective comparison of endoscopic ultrasound-guided fine-needle aspiration and surgical histology in upper gastrointestinal submucosal tumors. Endoscopy. 2010; 42(4):300-305. doi: 10.1055/s-0029-1244006

Sancho Moya C, Domingo LC, Eslava GP, Muñoz JC, Arana FA. Duodenal GIST: Surgical treatment based on the location. A single center experience with review of the literature. J Surg Med. 2020;4(7):592-96. doi: 10.28982/josam.760582

Yoshinaga S, Suzuki H, Oda I, Saito Y. Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 2011;23(1):29-33. doi: 10.1111/j.1443-1661.2011.01112.x

Lee LS, Saltzman JR, Bounds BC, Poneros JM, Brugge WR, Thompson CC. EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol 2005;3(3):231-36. doi: 10.1016/s1542-3565(04)00618-4






Research Article

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Ogutmen Koc D, Gökden Y. Retrospective analysis of the use of 22-gauge and 25-gauge needles for EUS-guided fine needle aspiration of solid lesions. J Surg Med [Internet]. 2021 Jan. 1 [cited 2024 May 25];5(1):22-5. Available from: