Study on Needle Efficacy in Histologic Core Procurement

A recent study published in Endoscopy found that the 22G needle is superior in terms of histologic core procurement. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) are the current standard of care for sampling pancreatic and peripancreatic masses. Recently, a 22G EUS-FNB needle with Franseen geometry was developed, and this device was also introduced in a 25G platform. A group of researchers compared the performance of the 25G and 22G Franseen needles for EUS-guided sampling of pancreatic and peripancreatic solid masses.

Methods

We conducted a parallel-group randomized non-inferiority trial at a tertiary-care center from November 2018 to May 2019. The primary outcome was the quality of the histologic core assessed using the Gerke score. The optimal histologic core is indicated by a Gerke score of 4 or 5, which enables optimal histologic interpretation. The overall diagnostic accuracy and adverse event rate were also evaluated.

Results

The results of the study are as follows:

• 140 patients were enrolled and randomized (1:1) to the 25G and 22G groups.
• Tissue acquisition by EUS-FNB was successful in all patients.
• The optimal histologic core procurement rate was 87.1% (61/70) for the 25G needle vs. 97.1% (68/70) for the 22G; difference −10% (95% confidence interval −17.35% to −2.65%).
• High quality specimens were more frequently obtained in the 22G group than in the 25G group (70.0% [49/70] vs. 28.6% [20/70], respectively; P < 0.001).
• The overall diagnostic accuracy did not differ between the groups (97.4% for 25G vs. 100% for 22G).

Thus, the researchers concluded that the 25G Franseen needle was inferior to the 22G needle in histologic core procurement. Therefore, for cases in which tissue architecture is pivotal for diagnosis, a 22G needle, which procures relatively higher quality specimens than the 25G needle, should be used.

Reference

A comparison between 25-gauge and 22-gauge Franseen needles for an endoscopic ultrasound-guided sampling of pancreatic and peripancreatic masses: a randomized non-inferiority study by Dongwook Oh et al. published in Endoscopy.

http://dx.doi.org/10.13039/100008497