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Endosc Int Open 2016; 04(05): E497-E505
DOI: 10.1055/s-0042-106958
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy[*]

A. Aziz Aadam
1   Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
,
Sachin Wani
2   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
,
Ashley Amick
1   Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
,
Janak N. Shah
3   Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States
,
Yasser M. Bhat
3   Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States
,
Christopher M. Hamerski
3   Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States
,
Jason B. Klapman
4   Division of Gastroenterology, Moffitt Cancer Center, Tampa, Florida, United States
,
V. Raman Muthusamy
5   Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, United States
,
Rabindra R. Watson
5   Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, United States
,
Alfred W. Rademaker
6   Department of Preventative Medicine, Northwestern University, Chicago, Illinois, United States
,
Rajesh N. Keswani
1   Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
,
Laurie Keefer
1   Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
,
Ananya Das
7   Arizona Digestive Health, Gilbert, Arizona, United States
,
Srinadh Komanduri
1   Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
› Author Affiliations
Further Information

Publication History

submitted 16 July 2015

accepted after revision 16 December 2015

Publication Date:
20 May 2016 (online)

Also available at
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Background and study aims: Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses.

Patients and methods: Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy.

Results: A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0 % vs. 67.1 %, P = 0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB: 91.7 % vs. FNA: 78.4 %, P = 0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2 % vs. 54.5 %, P = 0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (P = 0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5 %, P = 0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities.

Conclusions: Results of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB.

* Meeting presentations: Digestive Disease Week, May 2014


 

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