Tissue Quality Comparison Between Heparinized Wet Suction and Dry Suction in Endoscopic Ultrasound-Fine Needle Biopsy of Solid Pancreatic Masses: A Randomized Crossover Study

Meng-Ying Lin, Cheng-Lin Wu, Yung-Yeh Su, Chien-Jui Huang, Wei-Lun Chang, Bor-Shyang Sheu, Meng-Ying Lin, Cheng-Lin Wu, Yung-Yeh Su, Chien-Jui Huang, Wei-Lun Chang, Bor-Shyang Sheu

Abstract

Background/aims: A high-quality sample allows for next-generation sequencing and the administration of more tailored precision medicine treatments. We aimed to evaluate whether heparinized wet suction can obtain higher quality samples than the standard dry-suction method during endoscopic ultrasound (EUS)-guided biopsy of pancreatic masses.

Methods: A prospective randomized crossover study was conducted. Patients with a solid pancreatic mass were randomly allocated to receive either heparinized wet suction first or dry suction first. For each method, two needle passes were made, followed by a switch to the other method for a total of four needle punctures. The primary outcome was the aggregated white tissue length. Histological blood contamination, diagnostic performance and adverse events were analyzed as secondary outcomes. In addition, the correlation between white tissue length and the extracted DNA amount was analyzed.

Results: A total of 50 patients were enrolled, and 200 specimens were acquired (100 with heparinized wet suction and 100 with dry suction), with one minor bleeding event. The heparinized wet suction approach yielded specimens with longer aggregated white tissue length (11.07 mm vs 7.96 mm, p=0.001) and less blood contamination (p=0.008). A trend towards decreasing tissue quality was observed for the 2nd pass of the dry-suction method, leading to decreased diagnostic sensitivity and accuracy, although the accumulated diagnostic performance was comparable between the two suction methods. The amount of extracted DNA correlated positively to the white tissue length (p=0.001, Spearman̕s ρ=0.568).

Conclusions: Heparinized wet suction for EUS tissue acquisition of solid pancreatic masses can yield longer, bloodless, DNA-rich tissue without increasing the incidence of adverse events (ClinicalTrials.gov. identifier NCT04707560).

Keywords: Biopsy; DNA; Endoscopic ultrasound-guided fine needle aspiration; Heparin; Pancreatic neoplasms; fine-needle.

Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flow diagram of the study participants.
Fig. 2
Fig. 2
Outcome comparison based on overall pass order. (A) The white tissue length was longer by applying heparin wet-suction especially in overall passes 1 and 2. (B) The blood contamination was significantly lesser in overall passes 2 and 4 if using heparin wet-suction. (C, D) Diagnostic sensitivity and accuracy were similar no matter which suction method used, except in overall pass 2. *p

Fig. 3

The scatter diagram and the…

Fig. 3

The scatter diagram and the trend line of white tissue length and extracted…

Fig. 3
The scatter diagram and the trend line of white tissue length and extracted DNA amount. Each dot stood for a single specimen enrolled and the ρ value was done by Spearman rank correlation which showed a significantly positive correlation between white tissue length and DNA amount (ρ=0.568).

Fig. 4

Macroscopic view of acquired tissue…

Fig. 4

Macroscopic view of acquired tissue and the result of on-site evaluation. More red…

Fig. 4
Macroscopic view of acquired tissue and the result of on-site evaluation. More red blood cells (RBCs) dissociated from the specimen got by heparinized wet-suction method and precipitated on the plate (A) and more white tissue was separated from the acquired tissue (B). Only small number of RBCs dissociated from the specimen got by dry-suction method and precipitated on the plate (C), which resulted in shorter white tissue been separated (D).
Fig. 3
Fig. 3
The scatter diagram and the trend line of white tissue length and extracted DNA amount. Each dot stood for a single specimen enrolled and the ρ value was done by Spearman rank correlation which showed a significantly positive correlation between white tissue length and DNA amount (ρ=0.568).
Fig. 4
Fig. 4
Macroscopic view of acquired tissue and the result of on-site evaluation. More red blood cells (RBCs) dissociated from the specimen got by heparinized wet-suction method and precipitated on the plate (A) and more white tissue was separated from the acquired tissue (B). Only small number of RBCs dissociated from the specimen got by dry-suction method and precipitated on the plate (C), which resulted in shorter white tissue been separated (D).

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