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. 2019 Jan-Feb;8(1):50-57.
doi: 10.4103/eus.eus_11_18.

A retrospective histological comparison of EUS-guided fine-needle biopsy using a novel franseen needle and a conventional end-cut type needle

Shuntaro Mukai  1 , Takao Itoi  1 , Hiroshi Yamaguchi  2 , Atsushi Sofuni  1 , Takayoshi Tsuchiya  1 , Reina Tanaka  1 , Ryosuke Tonozuka  1 , Mitsuyoshi Honjo  1 , Mitsuru Fujita  1 , Kenjiro Yamamoto  1 , Yukitoshi Matsunami  1 , Yasutsugu Asai  1 , Takashi Kurosawa  1 , Yuichi Nagakawa  3
Affiliations

A retrospective histological comparison of EUS-guided fine-needle biopsy using a novel franseen needle and a conventional end-cut type needle

Shuntaro Mukai et al. Endosc Ultrasound. 2019 Jan-Feb.

Abstract

Background and objectives: Recently, a 22G Franseen needle for EUS-guided fine-needle biopsy (EUS-FNB) with three novel symmetric heels has been developed to adequately obtain a core tissue.

Methods: All 38 consecutive patients with pancreatic masses who underwent EUS-FNB using a Franseen needle were investigated retrospectively to assess the efficacy and safety of EUS-FNB using the Franseen needle. Then, the EUS-FNB outcomes and histological assessments of the tissue obtained by EUS-FNB using the Franseen needle and EUS-FNA using the conventional end-cut type needle for each of the 30 pancreatic ductal adenocarcinoma cases were compared.

Results: An accurate histological diagnosis of the Franseen needle was achieved with a mean of 2 passes in 97.4% of patients. Although the accurate histological diagnosis rate of pancreatic ductal adenocarcinoma was not significantly different (96.7% vs. 93.3%, P = 0.55), the mean number of passes in the Franseen needle was significantly less than that in the conventional needle (2.1 ± 0.4 vs. 3.2 ± 0.8, P < 0.001). The presence of desmoplastic fibrosis with neoplastic cellular elements and venous invasion were significantly higher (96.7% vs. 40.0%, P < 0.001 and 23.3% vs. 0%, P < 0.01, respectively) and the amount of obtained tissue was significantly larger with the Franseen needle (2.13 mm2 vs. 0.45 mm2, P < 0.001).

Conclusions: EUS-FNB using the Franseen needle enables the acquisition of a larger amount of tissue sample and achieves an accurate histological diagnosis with a smaller number of passes than the conventional end-cut type needle.

Keywords: Endoscopic ultrasound; fine needle biopsy; histology; pancreatic cancer.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Upper needle: A conventional 22G end-cut type needle with beveled tips. Lower needle: A novel 22-guage Franseen needle with 3 symmetric heels (Courtesy of Boston Scientific Corp.)
Figure 2
Figure 2
Three large tissue clots were selected in a slide, and the area of the tissue clot was calculated by measuring the major axis and the minor axis (H and E, ×20)
Figure 3
Figure 3
Scatter plot of the amount of obtained tissues evaluated by the total area of the 3 tissue clots for EUS-FNAB using each needle
Figure 4
Figure 4
(a) A small amount of fragmented adenocarcinoma cell clusters obtained using a conventional end-cut type needle (H and E, ×100), which is difficult to differentiate from contaminated gastric foveolar epithelium. The evaluation of invasive growth is impossible based on this section. (b) A core tissue including the desmoplastic fibrosis with neoplastic cellular elements obtained using a novel Franseen needle (H and E, ×100). Destructive invasion growth is apparent, leading to an accurate diagnosis for malignancy
Figure 5
Figure 5
A large amount of core tissue including the venous, lymphatic, or nerve invasion, which helps a pathologist to make a definitive pathological diagnosis of adenocarcinoma. (a) Venous invasion of adenocarcinoma evaluated by elastic Van Gieson staining (×200). (b) Lymphatic invasion of adenocarcinoma evaluated by immunohistochemical assessment of D2-40 (×200). (c) Nerve invasion evaluated by immunohistochemical assessment of S-100 (×200)
Figure 6
Figure 6
Obtained core tissue by EUS-guided fine-needle biopsy using a Franseen needle for lymphoplasmacytic sclerosing pancreatitis (type 1 autoimmune pancreatitis). (a) Storiform fibrosis (H and E, ×100). (b) Extensive infiltration of lymphocyte plasma cells (H and E, ×400). (c) Markedly increased numbers of IgG4-positive plasma cells (×400). (d) Obliterative phlebitis evaluated by elastic van Gieson staining (×200)
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