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Randomized Controlled Trial
. 2009 Dec;70(6):1093-7.
doi: 10.1016/j.gie.2009.05.037. Epub 2009 Jul 28.

EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles

Uzma D Siddiqui  1 , Federico Rossi, Lawrence S Rosenthal, Manmeet S Padda, Visvanathan Murali-Dharan, Harry R Aslanian
Affiliations
Randomized Controlled Trial

EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles

Uzma D Siddiqui et al. Gastrointest Endosc. 2009 Dec.

Abstract

Background: There is a lack of prospective, randomized studies comparing the diagnostic yield and complication rates of 22-gauge and 25-gauge needles during EUS-FNA of solid pancreatic masses.

Objectives: Our primary aim was to compare the diagnostic yield of 22-gauge and 25-gauge needles. Secondary aims included determining the number of needle passes performed, ease of needle passage, and complications.

Design: Prospective, randomized study.

Setting: Tertiary referral centers at Yale University School of Medicine, New Haven, Connecticut, and Virginia Piper Cancer Institute, Minneapolis, Minnesota.

Patients: Patients with a suspected solid pancreatic mass from February 2007 to June 2008 were enrolled.

Interventions: Patients were randomized to EUS-FNA with a 22-gauge or 25-gauge needle.

Main outcome measurements: A diagnostic result was defined as cytology findings positive for malignant cells.

Results: A total of 131 patients were enrolled: EUS-FNA was performed with a 22-gauge needle in 64 patients and with a 25-gauge needle in 67 patients. Cytology was diagnostic in 120 (91.6%) of 131 patients overall: 56 (87.5%) of 64 with 22-gauge needles and 64 (95.5%) of 67 with 25-gauge needles (no statistically significant difference was found between the 2 groups; P=.18). A similar number of passes was performed in both arms (mean [SD] 2.6 [1.2] each; P=.96). There were no complications in either group.

Limitation: A larger number of patients is needed to determine small differences in diagnostic yield.

Conclusions: This is the first prospective, randomized trial comparing 22-gauge and 25-gauge needles in EUS-FNA of solid pancreatic masses. We achieved equally high diagnostic yields by using a similar number of passes, showing that 25-gauge needles are an effective alternative to 22-gauge needles.

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Comment in

  • EUS-guided FNA: better samples with smaller needles?
    Gerke H. Gerke H. Gastrointest Endosc. 2009 Dec;70(6):1098-100. doi: 10.1016/j.gie.2009.06.033. Gastrointest Endosc. 2009. PMID: 19962501 No abstract available.
  • Endoscopic ultrasonography.
    Polkowski M. Polkowski M. Endoscopy. 2010 Jan;42(1):68-72. doi: 10.1055/s-0029-1215223. Epub 2010 Jan 11. Endoscopy. 2010. PMID: 20066593 No abstract available.
  • EUS aspiration needle size: smaller is better?
    Fanning S, Kwok A, Jones B, Leong R. Fanning S, et al. Gastrointest Endosc. 2010 Oct;72(4):904-5; author reply 905. doi: 10.1016/j.gie.2010.01.067. Gastrointest Endosc. 2010. PMID: 20883873 No abstract available.

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