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KMID : 1048120140030020104
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International Journal of Gastrointestinal Intervention
2014 Volume.3 No. 2 p.104 ~ p.109
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What is the best method for endoscopic ultrasound-guided fine needle aspiration? Needle types and aspiration techniques
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Hara Kazuo
Mizuno Nobumasa
Hijioka Susumu
Imaoka Hiroshi
Tajika Masahiro
Tanaka Tsutomu
Ishihara Makoto
Niwa Yasumasa
Yamao Kenji
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Abstract
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Background: Many factors such as the size and type of needle and negative pressure can affect the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, because many biases exist in clinical studies of humans, particularly in terms of individual differences among participants, results are largely dependent on the characteristics of the patients and tumors. The aim of this study was to evaluate the properties of EUS-FNA needles and aspiration techniques using animal and artificial models under stable conditions.
Methods: We performed EUS-FNA on a pig liver under general anesthesia in Protocol 1. We used all types (soft-type, stiff-type, and reverse-beveled needles) and all sizes of needles with negative pressure applied using a 20-mL syringe or the slow-pull technique. All the obtained specimens were fixed in formalin for the cell block method. The specimens were scored according to the our own grading system. In Protocol 2, EUS-FNA was performed using three materials: Japanese sweet bean jelly, tofu, and cow liver. The obtained specimens were placed on the dish one by one. The FNA specimens were evaluated macroscopically and compared with each other.
Results: In Protocol 1, the mean ± standard deviation score for reverse-beveled needles (4.1 ± 1.41) was significantly higher than that for soft-type needles (3.5 ± 1.79; P < 0.05, Dunn’s test). However, there was no significant difference between stiff-type and reverse-beveled needles. The score for each size of needle showed no significant difference, even between 25 gauge (G) and 19 G. Comparing the slow-pull technique with 20-mL negative pressure, the slow-pull technique provided a small specimen but less blood in Protocol 2. Negative pressure was not useful for EUS-FNA of a hard tumor model.
Conclusion: The score for the reverse-beveled needle was better than that of the soft-type needle. The slow-pull technique may be useful for a bloody tumor, but it provides less specimen. We should select the EUS-FNA method based on the relevant patient and tumor characteristics.
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KEYWORD
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cyto-histopathological diagnosis, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), tumor diagnosis, fine needle, slow pull
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