A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses

作者：Lee Jun Kyu; Choi Jong Hak; Lee Kwang Hyuck^*; Kim Kwang Min; Shin Jae Uk; Lee Jong Kyun; Lee Kyu Taek; Jang Kee Taek

来源：Gastrointestinal Endoscopy, 2013, 77(5): 745-751.

DOI：10.1016/j.gie.2012.12.009

Background: There is no standardization of the use of suction during puncturing of a target in pancreatic EUS-guided FNA (EUS-FNA). It is also debatable whether expressing aspirates from the needle by the traditional method of reinserting the stylet is more effective than by air flushing, which is easier and safer. %26lt;br%26gt;Objective: To optimize sampling techniques in pancreatic EUS-FNA. %26lt;br%26gt;Design: Prospective, comparative trial. %26lt;br%26gt;Setting: Tertiary-care referral center. %26lt;br%26gt;Patients: Eighty-one consecutive patients with solid pancreatic masses. %26lt;br%26gt;Intervention: Four punctures were performed for each mass in random order by a 2 x 2 factorial design. Sample quality and diagnostic yield were compared between samples with suction (S+) versus no suction (S-) and expressed by reinserting the stylet (RS) versus air flushing (AF). %26lt;br%26gt;Main Outcome Measurements: Sample quality by the number of diagnostic samples, cellularity, bloodiness, and air-drying artifact; diagnostic yield by accuracy, sensitivity, and specificity. %26lt;br%26gt;Results: The number of diagnostic samples (72.8% vs 58.6%; P = .001), cellularity (odds ratio [OR] 2.12; 95% confidence interval [CI], 1.37-3.30; P %26lt; .001), bloodiness (OR 1.46; CI, 1.28-1.68; P %26lt; .001), accuracy (85.2% vs 75.9%; P = .004), and sensitivity (82.4% vs 72.1%; P = .005) were higher in S+ than in S-. Bloodiness was lower in AF than in RS (OR 1.16; CI, 1.03-1.30; P = .017). %26lt;br%26gt;Limitations: Single-center trial, 2 kinds of needle gauges, and no immediate cytopathology evaluation. %26lt;br%26gt;Conclusion: Puncturing with suction and expressing by air flushing may be used preferentially in pancreatic EUS-FNA because they were more effective and convenient techniques. (Clinical trial registration number: NCT01354795.) (Gastrointest Endosc 2013; 77:745-51.)

• 出版日期2013-5