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A Comparative Study of 22G versus 19G Needles for EUS-Guided Biopsies for Parenchymal Liver Disease: Are Thinner Needles Better?

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Abstract

Background and Aims

Data on comparative efficacy of various available endoscopic ultrasound-guided liver biopsy (EUS-LB) needles are limited. We sought to compare the performance of a novel Franseen-tip 22G fine-needle biopsy (FNB) device to that of 19G needle platforms for liver parenchyma.

Methods

Consecutive patients referred for EUS and suspected to have hepatic parenchymal disease underwent EUS-LB using different EUS needles and were included in this retrospective study. Two blinded expert liver pathologists independently reviewed and reported on: total number of tissue fragments, length of longest fragment, number of complete and incomplete portal tracts (CPT and IPT), and specimen adequacy.

Results

A 22G Franseen-tip needle (A) was used in 30 patients; 19G Tru-Cut needle (B) in 50 patients; 19G reverse beveled non-Tru-Cut needle (C) in 27 patients; and a 19G flexible non-Tru-Cut needle (D) in 28 patients. In the order of needles, A, B, C and D,  > 10 tissue fragments were obtained in 100%, 6%, 82%, and 96% samples, the mean number of CPTs was 6.9; 3.0; 7.3; and 16.9, length of longest fragment was 3.8, 4. 7, 3.9, and 8.4 mm, and specimen adequacy was 66.7%, 46%, 82.1%, and 81.5%, respectively. A positive correlation was obtained between number of CPTs and length of longest fragment in samples accrued by 19G needles.

Conclusion

EUS-LB specimens using 22G Franseen-tip needle appear highly fragmented, leading to inferior specimen adequacy compared to 19G non-Tru-Cut needles. We also report on using length of longest fragment as an additional criterion for specimen adequacy as it positively correlates with number of CPTs standard.

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Abbreviations

EUS:

Endoscopic ultrasound

LB:

Liver biopsy

PLB:

Percutaneous liver biopsy

TJLB:

Trans-jugular liver biopsy

EUS-LB:

Endoscopic ultrasound-guided liver biopsy

FNA:

Fine-needle aspiration

FNB:

Fine-needle biopsy

Needle A:

22G Franseen-tip needle

Needle B:

19G Tru-Cut needle

Needle C:

19G reverse beveled non-Tru-Cut needle

Needle D:

19G flexible non-Tru-Cut needle

CPT:

Complete portal tracts

IPT:

Incomplete portal tracts

19G:

19 Gauge

22G:

22 Gauge

25G:

25 Gauge

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Authors and Affiliations

  1. Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA

    Harsh K. Patel

  2. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, 46202-3082, USA

    Romil Saxena, Natalia Rush, Ariel Quickery, Mahmoud A. Rahal, Lindsey Temnykh, John DeWitt & Mohammad Al-Haddad

  3. Anand Institute of Management, Anand, Gujarat, India

    Suchi K. Patel

  4. Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO, USA

    Chandra S. Dasari

  5. University of South Alabama Health College of Medicine, Mobile, AL, USA

    Wadad Mneimneh

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  1. Harsh K. Patel
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Contributions

HKP analyzed and interpreted the data and drafted and critically revised the article; NR helped in conception or design of the work and data collection; SKP analyzed and interpreted the data and critically revised the article; CSD, WM, MR, and LT critically revised the article; AQ collected the data; RS and JDW involved in conception or design of the work, data collection, and critical revision of the article; MA-H helped in conception or design of the work, data collection, critical revision of the article, and final approval of the version to be published.

Corresponding author

Correspondence to Mohammad Al-Haddad.

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Conflict of interest

John DeWitt: research support from Pinnacle Biologic, Vyaire Medical, and Vascular Biogenics, Ltd. Mohammad Al-Haddad: teaching and research support, Boston Scientific and the remaining authors declares that they have no conflict of interest.

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Patel, H.K., Saxena, R., Rush, N. et al. A Comparative Study of 22G versus 19G Needles for EUS-Guided Biopsies for Parenchymal Liver Disease: Are Thinner Needles Better?. Dig Dis Sci 66, 238–246 (2021). https://doi.org/10.1007/s10620-020-06165-x

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