Heparin priming of EUS-FNA needles does not adversely affect tissue cytology or immunohistochemical staining

David L Diehl, Shaffer R S Mok, Harshit S Khara, Amitpal S Johal, H Lester Kirchner, Fan Lin, David L Diehl, Shaffer R S Mok, Harshit S Khara, Amitpal S Johal, H Lester Kirchner, Fan Lin

Abstract

Background and study aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) or biopsy (FNB) is an indispensable diagnostic tool. Improvements in needling technique have led to increasing tissue yields. Blood clogging of the needle can cause difficulties with specimen handling and stylet passage, which improves when the needle is primed with heparin before use. However, the effect of heparin on cytology, histology or immunochemistry (IHC) of FNA and FNB specimens is unknown. The goal of the study was to evaluate heparin priming on cytologic/histologic appearance, IHC staining, ease of stylet passage, and specimen bloodiness.

Patients and methods: This was a retrospective study of patients undergoing EUS-FNA/FNB. Needle sizes were 25 gauge (g), 22 g, and 19 g. Heparin priming of the needle was done and the stylet replaced ("dry heparin") or suction attached without replacing the stylet ("wet heparin"). Smears and cellblocks were examined by pathologists, and IHC staining were done as needed. Specimen bloodiness was compared with matched controls.

Results: Adequate tissue yields were obtained in all samples (37 heparin, 36 no heparin). Heparin priming did not exhibit negative effects on cytologic or histologic interpretation of the specimens, nor IHC. There was no difference in cellblock bloodiness between the heparin primed needle specimens and the non-heparin control group. .

Conclusions: Heparin priming of EUS-FNA or FNB needles does not negatively affect cytologic or histologic interpretation, nor interfere with IHC. In addition, heparin priming does not increase specimen bloodiness. When the "wet suction" technique is used for EUS-FNA, heparin priming can be used instead of saline priming of the EUS needle.

Conflict of interest statement

Competing interests Dr. Khara is a consultant for Medtronic-Covidien. Dr. Johal is a consultant for Boston Scientific Corporation. Dr. Diehl is a consultant for Boston Scientific Corporation and Olympus.

Figures

Fig. 1
Fig. 1
Grading scale of blood of cell block specimen. Photomicrographs show grading of the degree of blood present in a specimen. 0 (A): nearly absent of RBC; 1 + (B): monolayer of RBC, no cluster formation; 2 + (C): aggregates of RBC,  1 per HPF (× 400)
Fig. 2
Fig. 2
Grading of specimen blood, heparin versus non-heparin groups. Comparative data are shown, evaluating the degree of blood for the heparin priming group and control group. There was no statistical difference in the following scale parameters no: 0.41, 1 + : 0.1, 2 + : 0.94, 3 + 0.56. Overall there was no difference in the heparin priming and control group bloodiness (P = 0.49).

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Source: PubMed

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