Efficacy of 3 fine-needle biopsy techniques for suspected pancreatic malignancies in the absence of an on-site cytopathologist,Gastrointestinal Endoscopy

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Efficacy of 3 fine-needle biopsy techniques for suspected pancreatic malignancies in the absence of an on-site cytopathologist
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2018-11-04 , DOI: 10.1016/j.gie.2018.10.042
Ka Young Lee , Hyun Deuk Cho , Young Hwangbo , Jae Kook Yang , Su Jung Han , Hyun Jong Choi , Yun Nah Lee , Sang-Woo Cha , Jong Ho Moon , Young Deok Cho , Sang-Heum Park , Tae Hoon Lee

Background and Aims

EUS-guided fine-needle aspiration/biopsy (EUS-FNA/B) has a high diagnostic accuracy for pancreatic tumors. Most reports have focused on the diagnostic yield of cytology or histology; the ability of various FNA/B techniques to obtain an adequate mass of cells or tissue has rarely been investigated.

Methods

Patients with suspected pancreatic malignancy underwent EUS-FNB using a 22-gauge ProCore needle by either the stylet slow-pull-back technique (group A), conventional negative suction after stylet removal (group B), or non-suction after stylet removal (group C) in the absence of an on-site cytopathologist. The adequacy of the 3 techniques based on the diagnostic yield, cellularity, blood contamination, and core-tissue acquisition was evaluated.

Results

A total of 50 patients (27 males) were analyzed. The mean tumor size was 21 to 40 mm in 54%. The rate of a good or excellent proportion of cellularity was highest in group A compared with groups B and C (72% vs 60% vs 50%, P = .049). A >25% rate of blood contamination was more prevalent in group B (30% vs 42% vs 10%, P = .009). The rate of adequate core-tissue acquisition was not different (52% vs 34% vs 50%, P = .140). Based on the multivariate generalized estimation equation, the stylet slow-pull-back technique and a tumor size >40 mm were favorable factors for diagnostic adequacy.

Conclusions

The stylet slow-pull-back technique might enable acquisition of tissue and assessment of cellularity for the diagnosis of pancreatic tumors suspected to be malignant. (Clinical trial registration number: KCT0002190.)

中文翻译：

在没有现场细胞病理学家的情况下3种细针穿刺活检技术对可疑胰腺恶性肿瘤的疗效

背景和目标

EUS引导的细针穿刺活检/穿刺活检（EUS-FNA / B）对胰腺肿瘤具有很高的诊断准确性。大多数报告都集中在细胞学或组织学的诊断结果上。很少研究各种FNA / B技术获得足够质量的细胞或组织的能力。

方法

疑似胰腺恶性肿瘤的患者使用22规ProCore针通过探针慢速回拉技术（A组），探针去除后的常规负压抽吸（B组）或探针去除后不抽吸的方式进行EUS-FNB（A组） C组）在没有现场细胞病理学家的情况下。评估了基于诊断产量，细胞数量，血液污染和核心组织获取的3种技术的适当性。

结果

总共分析了50位患者（27位男性）。平均肿瘤大小为21至40毫米，占54％。与B组和C组相比，A组的良好或优异的细胞率比率最高（72％对60％对50％，P = .049）。B组中> 25％的血液污染率更为普遍（30％对42％对10％，P = .009）。充足的核心组织获取率没有差异（52％vs 34％vs 50％，P = .140）。基于多元广义估计方程，管心针慢速后推技术和肿瘤大小> 40 mm是诊断充分性的有利因素。