- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03485924
EUS FNB Versus FNA With On-Site Cytopathology in Solid Pancreatic Masses
Endoscopic Ultrasound With Fine Needle Biopsy Versus Fine Needle Aspiration With On-Site Cytopathology in the Evaluation of Solid Pancreatic Masses: Randomized Single Blinded Clinical Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Endoscopic ultrasound (EUS) guided fine needle aspiration (EUS-FNA) is the primary technique for tissue acquisition for pancreatic lesions. Despite widespread adoption of the techniques, the diagnostic yield of EUS-FNA for pancreatic lesion is highly variable, with sensitivities ranging from 64-95%, specificities ranging from 75-100% and overall diagnostic accuracy ranging from 78-95%.
Despite its mainstay as the primary technique for tissue acquisition, EUS-FNA has several limitations. The standard EUS-FNA does not routinely provide core biopsy specimen with preserved tissue architecture, which is required for immunohistochemical staining and for definitive diagnosis of conditions, such as lymphoma, gastrointestinal stromal tumors, Immunoglobulin G (IgG)-4-associated lymphoplasmacytic sclerosing pancreatitis. Furthermore, the diagnostic yield of EUS-FNA is highly dependent on the availability of bedside cytotechnologist or cytopathologist for rapid onsite evaluation (ROSE), which increases the overall cost required to perform EUS-FNA.
Recently, multiple dedicated EUS fine needle biopsy (FNB) needles have been developed to obtain core specimens. Early small studies have shown promising results with these EUS-FNB needles.
The objective of this paired cohort study is to evaluate the diagnostic accuracy of EUS-FNA with ROSE compared to EUS-FNA with ROSE. If EUS-FNB without ROSE is shown to be non-inferior to the current standard of care of EUS-FNA with ROSE in pancreatic lesions, this study has the potential to make EUS-guided tissue acquisition more economical (with elimination for the need for cytopathology staff onsite) as well as provide core histological specimen without sacrificing the overall diagnostic yield.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Eun Shin
- Phone Number: 410-614-0950
- Email: eshin3@jhmi.edu
Study Locations
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-
Maryland
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Baltimore, Maryland, United States, 21205
- Johns Hopkins
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patient ≥ 18 years of age referred for EUS-guided biopsy for pancreatic mass lesions
Exclusion Criteria:
- Refusal to consent form
- Uncorrectable coagulopathy (INR > 1.5)
- Uncorrectable thrombocytopenia (platelet < 50,000)
- Uncooperative patients
- Pregnant women (women of childbearing age will undergo urine pregnancy testing, which is routine for all endoscopic procedures)
- Medically unstable for sedation
- Entirely cystic lesions
- Lesions inaccessible to EUS
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: EUS-FNA with ROSE
EUS/FNA with ROSE will be performed using standard techniques via 22-g FNA needle (Cook Medical EchoTip Ultra or Boston Scientific Expect or Medtronic Beacon).
Lesions will be identified using EUS and punctured with the FNA needle (10-15 back and forth movements per needle pass, fanning as appropriate).
After the lesion is punctured, the stylet will be removed and 10cc suction will be applied.
FNA specimens will be processed for ROSE using standard techniques with bedside smear slide evaluation and liquid-based cytology and cell-block preparation.
|
EUS-FNA with ROSE vs EUS-FNB without ROSE
|
Active Comparator: EUS-FNB without ROSE
EUS/FNB without ROSE will be performed using similar techniques for tissue acquisition as FNA using 22-g FNB needle (Medtronic SharkCore or Boston Scientific Acquire).
Lesions will be identified using EUS and punctured with the 22-g FNB needle (10-15 back and forth movements per needle pass, fanning as appropriate).
After the lesion is punctured, the stylet will be removed and 10cc suction will be applied.
FNB samples will be placed directly into formalin containers and sent to be processed by surgical pathology.
|
EUS-FNA with ROSE vs EUS-FNB without ROSE
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The diagnostic accuracy of fine-needle biopsy (FNB) sampling without rapid onsite evaluation (ROSE) with the fine needle aspiration (FNA) with ROSE in pancreatic mass lesions
Time Frame: 2 years
|
Diagnostic accuracy will be defined as (true positive + true negative)/all samples. The final diagnosis will be based on one of the following criteria: (i) surgical pathology specimen from patients who underwent surgical resection; (ii) cytological or histopathological diagnosis of malignancy in patients with unresectable disease with appropriate imaging and clinical course of disease; (iii) cytological and histopathological diagnosis of benign disease with an appropriate clinical course of disease for minimum of 6 months. |
2 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Specimen adequacy
Time Frame: 2 years
|
This will be defined as the proportion of samples in which a final histopathological diagnosis could be made.
|
2 years
|
Percentage of histology cores obtained
Time Frame: 2 years
|
This will be defined as the proportion of samples in which a visible histology core biopsy was obtained
|
2 years
|
Number of passes
Time Frame: 2 years
|
Number of passes required for diagnosis
|
2 years
|
Rate of technical failures
Time Frame: 2 years
|
Technical failure was defined as the inability to perform the procedure, including the need to change the needle
|
2 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Mouen Khashab, Johns Hopkins University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- IRB00148609
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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