Endoscopy 2007; 39(8): 725-730
DOI: 10.1055/s-2007-966400
Original article

© Georg Thieme Verlag KG Stuttgart · New York

EUS-guided tissue sampling: comparison of ”dual sampling” (Trucut biopsy plus FNA) with ”sequential sampling” (Trucut biopsy and then FNA as required)

G.  P.  Aithal1 , G.  K.  Anagnostopoulos1 , W.  Tam2 , J.  Dean3 , A.  Zaitoun4 , G.  Kocjan5 , K.  Ragunath1 , S.  P.  Pereira2
  • 1Wolfson Digestive Diseases Centre, Queen’s Medical Centre University Hospital, Nottingham, United Kingdom
  • 2Department of Gastroenterology, University College Hospital, London, United Kingdom
  • 3Department of Gastroenterology, James Cook University Hospital, Middlesborough, United Kingdom
  • 4Department of Cellular Pathology, Queen’s Medical Centre University Hospital, Nottingham, United Kingdom
  • 5Department of Histopathology, University College Hospital, London, United Kingdom
Further Information

Publication History

eingereicht 23 May 2006

akzeptiert 7 February 2007

Publication Date:
10 July 2007 (online)

Background and study aims: Both endoscopic ultrasound- (EUS-) guided tissue sampling techniques, fine-needle aspiration (FNA) and Trucut biopsy, have advantages and limitations. The aim of this study was to develop a strategy of combining these two EUS-guided sampling techniques in order to maximize the diagnostic accuracy and minimize duplication.

Patients and methods: In this multicenter study we performed ”dual sampling” (i. e. with both FNA and Trucut biopsy) in 95 patients during phase 1 of the study and ”sequential sampling” (i. e. performing FNA only when Trucut biopsy tissue cores were macroscopically inadequate) in 72 patients during phase 2.

Results: During the study period, 167/401 patients referred for EUS-guided sampling were eligible for the study; only solid lesions were included. In 143/167 patients (86 %), sampling was performed via the transesophageal or transgastric routes. When the dual sampling strategy was used, an accurate diagnosis was achieved in 78/95 patients by FNA, compared with 85/95 by Trucut biopsy (P = 0.21). The combined accuracy of the dual sampling strategy was higher than FNA alone (88/95 vs. 78/95, P = 0.048), but was not significantly higher than Trucut biopsy alone (88/95 vs. 85/95, P = 0.61). Using the sequential sampling strategy, an accurate diagnosis was achieved in 66/72 patients (92 %) compared with 88/95 (93 %) for dual sampling (P = 1.0), and 8/72 patients (11 %) had to undergo FNA after Trucut biopsy failed to obtain an adequate sample. One patient with mediastinal tuberculosis developed a cold abscess following Trucut biopsy.

Conclusion: A sequential sampling strategy, in which EUS-guided Trucut biopsy is attempted first, and FNA performed only when Trucut biopsy fails to obtain a macroscopically adequate sample, achieves a diagnostic accuracy of 92 %, with 11 % of patients requiring both sampling procedures.

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G. P. Aithal, MD, PhD 

D Floor, South Block Queen’s Medical Centre

Nottingham NG7 2UH

United Kingdom

Fax: +44-115-9709012

Email: guru.aithal@nuh.nhs.uk