Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles

Shaffer R S Mok, David L Diehl, Amitpal S Johal, Harshit S Khara, Bradley D Confer, Prashant R Mudireddy, Alicia H Kovach, Mia M Diehl, H Lester Kirchner, Zong-Ming E Chen, Shaffer R S Mok, David L Diehl, Amitpal S Johal, Harshit S Khara, Bradley D Confer, Prashant R Mudireddy, Alicia H Kovach, Mia M Diehl, H Lester Kirchner, Zong-Ming E Chen

Abstract

Background and study aims Endoscopic ultrasound-guided liver biopsy uses a 19-gauge (G) needle for parenchymal liver biopsies. We evaluated tissue yields with a 22G fine-needle biopsy (FNB) versus 19G FNA fine-needle aspirate (FNA) device. Patients and methods Biopsies were obtained from 20 patients using the 19G FNA and 22G FNB randomizing each in a cross-over fashion with a blinded outcome assessor. Tissue adequacy for histologic evaluation was the primary outcome, or the proportion of specimens obtaining pathologic diagnosis (portal structures ≥ 5 or length of the longest piece ≥ 15 mm). Additional secondary outcomes included portal and centrilobular inflammation/fibrosis, length of the longest piece, aggregate specimen length, and small (< 5 mm), medium (5 - 8 mm) and large (> 8 mm) fragments. Results were compared in a per needle basis. Patients with cirrhosis were excluded. Results Eighty biopsies (40 each 19G FNA and 22G FNB) were obtained. Tissue adequacy was greater for the 19G FNA (88 %) versus 22G FNB (68 %), ( P = 0.03). There was no difference in total portal structures for the 19G FNA (7.4) and 22G FNB (6.1), ( P = 0.28). There was no difference in pre-processing outcomes. After processing, length of the longest piece was higher for the 19G FNA (9.1 mm) versus 22G FNB (6.6 mm), ( P = 0.02). More total post-processing small fragments 29.9 versus 20.7, ( P = 0.01) and fewer large fragments 1.0 versus 0.4 for the 22G FNB ( P = 0.01) were detected. Conclusions Tissue adequacy was higher for the 19G FNA versus 22G FNB needle. The 22G FNB needle produced samples more prone to fragmentation during specimen processing.

Conflict of interest statement

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

Figures

Fig. 1
Fig. 1
Flow diagram with enrollment and outcomes.
Fig. 2
Fig. 2
Comparison of portal structures, pre- and post-processing length of the longest piece for 19G FNA versus 22G FNB EUS-LB needles. Bars on left corresponded to 19G FNA needle and right bars 22G FNB. There was no significant difference in portal structures or pre-processing length of the longest piece, but there was a statistical difference (P = 0.02) for post-processing length of the longest piece. EUS-LB, endoscopic ultrasound-guided liver biopsy; g, gauge; ns, not significant.
Fig. 3
Fig. 3
Pre- and post-processing fragment length for 19G FNA versus 22G FNB EUS-LB needles. Bars depicting the mean total number of small ( 8 mm) fragments. There was no difference in small, medium or large fragments before histologic processing, but there was a higher number of small fragments (P = 0.01) and lower number of large fragments (P = 0.01) for the 22G FNB as compared with 19G FNA needle. EUS-LB, endoscopic ultrasound-guided liver biopsy; g, gauge
Fig. 4
Fig. 4
19G FNA and 22G FNB pre-processing gross images and post-processing histology.Upper panels (left to right) 22G FNB specimen gross image, post-processing histology image,19G FNA specimen post-processing histology image, 19G FNA specimen gross image. Lower panels (left to right) 22G FNB post-processing histology demonstrating fragmentation, 19G FNA post-processing histology with limited fragmentation.

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Source: PubMed

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