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Comparative Study
. 2016 Sep;84(3):424-433.e2.
doi: 10.1016/j.gie.2016.01.068. Epub 2016 Feb 10.

EUS Needle Identification Comparison and Evaluation study (with videos)

Shou-Jiang Tang  1 , Andreas S Vilmann  2 , Adrian Saftoiu  3 , Wanmei Wang  4 , Costin Teodor Streba  5 , Peter P Fink  6 , Michael Griswold  4 , Ruonan Wu  1 , Christoph F Dietrich  7 , Christian Jenssen  8 , Michael Hocke  9 , Marcus Kantowski  10 , Jürgen Pohl  11 , Paul Fockens  12 , Jouke T Annema  12 , Erik H F M van der Heijden  13 , Roald Flesland Havre  14 , Khanh Do-Cong Pham  14 , Rastislav Kunda  15 , Pierre H Deprez  16 , Jinga Mariana  17 , Enrique Vazquez-Sequeiros  18 , Alberto Larghi  19 , Elisabetta Buscarini  20 , Pietro Fusaroli  21 , Maor Lahav  22 , Rajesh Puri  23 , Pramod Kumar Garg  24 , Malay Sharma  25 , Fauze Maluf-Filho  26 , Anand Sahai  27 , William R Brugge  28 , Linda S Lee  29 , Harry R Aslanian  30 , Andrew Y Wang  31 , Vanessa M Shami  31 , Arnold Markowitz  32 , Ali A Siddiqui  33 , Girish Mishra  34 , James M Scheiman  35 , Gerard Isenberg  36 , Uzma D Siddiqui  37 , Raj J Shah  38 , James Buxbaum  39 , Rabindra R Watson  40 , Field F Willingham  41 , Manoop S Bhutani  42 , Michael J Levy  43 , Cynthia Harris  44 , Michael B Wallace  45 , Christian Pállson Nolsøe  2 , Torben Lorentzen  2 , Niels Bang  15 , Sten Mellerup Sørensen  15 , Odd Helge Gilja  46 , Mirko D'Onofrio  47 , Fabio Piscaglia  21 , Norbert Gritzmann  48 , Maija Radzina  49 , Zeno Adrian Sparchez  50 , Paul S Sidhu  51 , Simon Freeman  52 , Timothy C McCowan  53 , Cyrillo Rodrigues de Araujo Jr  53 , Akash Patel  53 , Mohammad Adel Ali  53 , Garth Campbell  53 , Edward Chen  54 , Peter Vilmann  2
Affiliations
Comparative Study

EUS Needle Identification Comparison and Evaluation study (with videos)

Shou-Jiang Tang et al. Gastrointest Endosc. 2016 Sep.

Abstract

Background and aims: EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development.

Methods: Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices.

Results: There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001).

Conclusions: All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.

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Figures

Figure 1
Figure 1
Image of all 10 study needles showing the needle tips (double-headed arrows), shafts, and treated mid shafts to enhance their echogenicity.
Figure 2
Figure 2
Image showing the bench-top testing setup: a tissue equivalent phantom block and the performing endosonographer (PV).
Figure 3
Figure 3
Endoscopic ultrasonographic images showing different echogenicity of three studied needles at about 30° and 50° needle insertion angles: one prototype needle (5), Medi-Globe; EchoTip Ultra (10), Cook Medical; EZ Shot2 (4), Olympus.
Figure 4
Figure 4
Endoscopic ultrasonographic images showing different echogenicity of all 10 studied needles at about 50° insertion angles.
Figure 5
Figure 5
Comparisons of rankings between NICE-E and NICE-R study groups. All ratings and rankings are similar without statistical differences. TED: tip echo-definition. SED: shaft echo-definition.
Figure 6
Figure 6
Overall rankings of 10 studied needles by a combined NICE-E and NICE-R study group. TED: tip echo-definition. SED: shaft echo-definition.
Figure 7
Figure 7
Endoscopic ultrasonographic images demonstrating the authors’ hypothesis of the higher angle the better echogenicity (HABE) phenomenon. The ultrasound fan hits the treated area of the needle and is reflected in a spread manner. At a lower angle of 30° (top image), the ultrasound emitter/receiver recollects less spread-out reflection. At a higher angle of 50° (middle image), the ultrasound emitter/receiver recollects a higher level of spread out reflection. The bottom is a composite image showing and comparing both scenarios.
See this image and copyright information in PMC

Comment in

References

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