Retrospective analysis of the use of 22-gauge and 25-gauge needles for EUS-guided fine needle aspiration of solid lesions
Keywords: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.
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
- 157 360
How to Cite
Copyright (c) 2021 Deniz Ogutmen Koc, Yasemin Gökden
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.