Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-0903-2565
Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a randomized study
TRIAL REGISTRATION: Single center, prospective, randomized crossover trial NCT03109639 at clinicaltrials.govPublication History
submitted 11 December 2018
accepted after revision 18 March 2019
Publication Date:
24 July 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201908/lookinside/thumbnails/1459_10-1055-a-0903-2565-1.jpg)
Abstract
Background and study aims Recently, a new Franseen design endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle was developed with the goal of providing more tissue for histology. We compared the tissue adequacy rate and nucleic acid yield of 22G EUS-FNB vs. 22G endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), in solid gastrointestinal and extra-intestinal lesions.
Patients and methods We conducted a randomized crossover study and recruited 36 patients. We performed three passes for pancreatic lesions and two passes for other lesions, using each needle. We blinded the pathologist to needle assignment. We assessed the diagnostic tissue adequacy rate and compared the total tissue area, diagnostic tissue area, and desmoplastic stroma (DS) area in cases of carcinoma. We also examined the nucleic acid yield of the two needles in pancreatic lesions.
Results The lesions included 20 pancreatic masses (55 %), six gastric subepithelial lesions (17 %), five lymph nodes (14 %) and five other abdominal masses (14 %). Mean ± SD lesion size was 3.8 ± 2.0 cm. The final diagnosis was malignant in 27 lesions (75 %) and benign in nine lesions (25 %). We found EUS-FNB procured significantly more median total tissue area (5.2 mm2 vs. 1.9 mm2, P < 0.001), diagnostic tissue area (2.2 mm2 vs. 0.9 mm2, P = 0.029), and DS area (2 mm2 vs. 0.1 mm2, P = 0.001) in lesions diagnosed as carcinoma (n = 23), as compared to EUS-FNA. In pancreatic lesions, EUS-FNB obtained significantly more nucleic acid than EUS-FNA (median; 4,085 ng vs. 2912 ng, P = 0.02). There was no difference in the cellblock or rapid on-site cytological evaluation (ROSE) diagnostic yield between the needles.
Conclusion The 22G EUS-FNB provides more histological core tissue and adequate nucleic acid yield compared to 22G EUS-FNA. In this study, the diagnostic performance was similar between the needles
-
References
- 1 Itoi T, Sofuni A, Itokawa F. et al. Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions. Dig Endosc 2011; 23: 17-21
- 2 Early DS, Ben-Menachem T, Decker GA. et al. Appropriate use of GI endoscopy. Gastrointest Endosc 2012; 75: 1127-1131
- 3 Lorenzo F, Alberto L. et al. Endoscopic ultrasound-guided fine needle aspiration: How to obtain a core biopsy?. Endosc Ultrasound 2014; 3: 71-81
- 4 Iglesias-Garcia J, Poley JW, Larghi A. et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196
- 5 Jenssen C, Dietrich CF. Endoscopic ultrasound-guided fine needle aspiration biopsy and trucut biopsy in gastroenterology – An overview. Best Pract Res Clin Gastroenterol 2009; 23: 743-759
- 6 Rastogi A, Wani S, Gupta N. et al. A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet. Gastrointest Endosc 2011; 74: 58-64
- 7 Puri R, Vilmann P, Săftoiu A. et al. Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis. Scand J Gastroenterol 2009; 44: 499-504
- 8 Sachin W. Basic techniques in endoscopic ultrasound-guided fine-needle aspiration: Role of a stylet and suction. Endosc Ultrasound 2014; 3: 17-21
- 9 Bang JY, Hebert-Magee S, Trevino J. et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
- 10 Vanbiervliet G, Napoléon B, Saint Paul MC. et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46: 1063-1070
- 11 Săftoiu 1 A, Vilmann P, Guldhammer Skov B. et al. Endoscopic ultrasound (EUS)-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: a prospective study. Scand J Gastroenterol 2007; 42: 117-125
- 12 Tian L, Tang AL, Zhang L. et al. Evaluation of 22G fine-needle aspiration (FNA) versus fine-needle biopsy (FNB) for endoscopic ultrasound-guided sampling of pancreatic lesions: a prospective comparison study. Surg Endosc 2018; 32: 3533-3539
- 13 Noh DH, Choi K, Gu S. et al. Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial. Scand J Gastroenterol 2018; 53: 94-99
- 14 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48: 339-349
- 15 Bang JY, Hebert-Magee S, Hasan MK. et al. Endoscopic ultrasonography-guided biopsy using a Franseen needle design: Initial assessment. Dig Endosc 2017; 29: 338-346
- 16 Al-Haddad M, Patel K, Othman MO. Prospective assessment of the performance of a new fine needle biopsy device at 2 large referral centers [abstract]. Gastrointest Endosc 2017; 85: AB333
- 17 Mitri RD, Rimbaş M, Attili F. et al. Performance of a new needle for endoscopic ultrasound-guided fine-needle biopsy in patients with pancreatic solid lesions: A retrospective multicenter study. Endosc Ultrasound 2018; 7: 329-334
- 18 Mukai S, Itoi T, Yamaguchi H. et al. A retrospective histological comparison of EUS-guided fine-needle biopsy using a novel Franseen needle and a conventional end-cut type needle. Endosc Ultrasound 2019; 8: 50-57
- 19 Bang JY, Hebert-Magee S, Navaneethan U. et al. EUS-guided fine needle biopsy of pancreatic masses can yield true histology: results of a randomized trial. Gut 2018; 67: 2081-2084
- 20 Wani S, Muthusamy VR, McGrath CM. et al. AGA White Paper: Optimizing Endoscopic Ultrasound-Guided Tissue Acquisition and Future Directions. Clin Gastroenterol Hepatol 2018; 16: 318-327
- 21 Yang MJ, Yim H, Hwang JC. et al. Endoscopic ultrasound-guided sampling of solid pancreatic masses: 22-gauge aspiration versus 25-gauge biopsy needles. BMC Gastroenterol 2015; 15: 122
- 22 Jovani M, Abidi WM, Lee LS. Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study. Scand J Gastroenterol 2017; 52: 784-787
- 23 Bang JY, Hebert-Magee S, Navaneethan U. et al. Randomized trial comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy sampling of solid pancreatic mass lesions. Gastrointest Endosc 2018; 87: 1432-1438
- 24 Leung Ki EL, Lemaistre AI, Fumex F. et al. Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation. Endosc Int Open 2019; 7: E189-E194
- 25 Abdelfatah MM, Grimm IS, Gangarosa LM. et al. Cohort study comparing the diagnostic yields of 2 different EUS fine-needle biopsy needles. Gastrointest Endosc 2018; 87: 495-500
- 26 Whatcott CJ, Diep CH, Jiang P. et al. Desmoplasia in primary tumors and metastatic lesions of pancreatic cancer. Clin Cancer Res 2015; 21: 3561-3568
- 27 Bahrami A, Khazaei M, Bagherieh F. et al. Targeting stroma in pancreatic cancer: Promises and failures of targeted therapies. J Cell Physiol 2017; 232: 2931-2937
- 28 Nicolle R, Blum Y, Marisa L. et al. Pancreatic adenocarcinoma therapeutic targets revealed by tumor-stroma cross-talk analyses in patient-derived xenografts. Cell Rep 2017; 21: 2458-2470
- 29 Chantrill LA, Nagrial AM, Watson C. et al. Precision medicine for advanced pancreas cancer: the individualized molecular pancreatic cancer therapy (IMPaCT) trial. Clin Cancer Res 2015; 21: 2029-2037
- 30 Berry W, Lundy J, Croagh D. et al. Reviewing the utility of EUS-FNA to advance precision medicine in pancreatic cancer. Cancers (Basel) 2018; 10
- 31 Gleeson FC, Kipp BR, Voss JS. et al. Endoscopic ultrasound fine-needle aspiration cytology mutation profiling using targeted next-generation sequencing: personalized care for rectal cancer. Am J Clin Pathol 2015; 143: 879-888
- 32 Bellevicine C, Vita GD, Malapelle U. et al. Applications and limitations of oncogene mutation testing in clinical cytopathology. Semin Diagn Pathol 2013; 30: 284-297
- 33 Wei S, Lieberman D, Morrissette JJ. et al. Using “residual” FNA rinse and body fluid specimens for next-generation sequencing: an institutional experience. Cancer Cytopathol 2016; 124: 324-329
- 34 Roy-Chowdhuri S, Stewart J. Preanalytic variables in cytology: lessons learned from next-generation sequencing. Arch Pathol Lab Med 2016; 140: 1191-1199
- 35 Roy-Chowdhuri S, Goswami RS, Chen H. et al. Factors affecting the success of next-generation sequencing in cytology specimens. Cancer Cytopathol 2015; 123: 659-668
- 36 Roy-Chowdhuri S, Chen H, Singh RR. et al. Concurrent fine needle aspirations and core needle biopsies: a comparative study of substrates for next-generation sequencing in solid organ malignancies. Mod Pathol 2017; 30: 499-508
- 37 Kandel P, Wallace MB. Advanced EUS-Guided tissue acquisition methods for pancreatic cancer. Cancers (Basel) 2018; 10
- 38 Noh DH. et al. Factors of endoscopic ultrasound fine-needle aspiration for successful next-generation sequencing in pancreatic cancer. Gastrointest Endosc 2015; 83: AB334
- 39 Navina S, McGrath K, Chennat J. et al. Adequacy assessment of endoscopic ultrasound-guided, fine-needle aspirations of pancreatic masses for theranostic studies: optimization of current practices is warranted. Arch Pathol Lab Med 2014; 138: 923-928
- 40 Pujan K, Aziza N, Ghassan T. et al. Su1326 feasibility of whole exome sequencing and genomic profiling of pancreas tumor tissue obtained with a novel fork-tipped EUS- guided fine needle core biopsy. 2017; 85: AB335-AB336
- 41 Rodriguez SA, Impey SD, Pelz C. et al. RNA sequencing distinguishes benign from malignant pancreatic lesions sampled by EUS-guided FNA. Gastrointest Endosc 2016; 84: 252-258
- 42 Lawson MH, Rassl DM, Cummings NM. et al. Tissue banking of diagnostic lung cancer biopsies for extraction of high quality RNA. J Thorac Oncol 2010; 5: 956-963
- 43 Dejmek A, Zendehrokh N, Tomaszewska M. et al. Preparation of DNA from cytological material. Cancer Cytopathol 2013; 121: 344-353