A prospective comparison of EUS-guided FNA using 25-gauge and 22-gauge needles

Hiroo Imazu, Yujiro Uchiyama, Hiroshi Kakutani, Kei-Ichi Ikeda, Kazuki Sumiyama, Mitsuru Kaise, Salem Omar, Tiing Leong Ang, Hisao Tajiri, Hiroo Imazu, Yujiro Uchiyama, Hiroshi Kakutani, Kei-Ichi Ikeda, Kazuki Sumiyama, Mitsuru Kaise, Salem Omar, Tiing Leong Ang, Hisao Tajiri

Abstract

Background and aims: There are limited data on the differences in diagnostic yield between 25-gauge and 22-gauge EUS-FNA needles. This prospective study compared the difference in diagnostic yield between a 22-gauge and a 25-gauge needle when performing EUS-FNA.

Methods: Forty-three patients with intraluminal or extraluminal mass lesions and/or lymphadenopathy were enrolled prospectively. EUS-FNA was performed for each mass lesion using both 25- and 22-gauge needles. The differences in accuracy rate, scoring of needle visibility, ease of puncture and quantity of obtained specimen were evaluated.

Results: The overall accuracy of 22- and 25-gauge needle was similar at 81% and 76% respectively (N.S). Likewise the visibility scores of both needles were also similar. Overall the quantity of specimen obtained higher with the 22-gauge needle (score: 1.64 vs. P < .001). However the 25-gauge needle was significantly superior to the 22-gauge needle in terms of ease of puncture (score: 1.9 vs. 1.29, P < .001) and in the quantity of specimen in the context of pancreatic mass EUS-FNA (score: 1.8 vs. 1.58, P < .05).

Conclusion: The 22-gauge and 25-gauge needles have similar overall diagnostic yield. The 25-gauge needle appeared superior in the subset of patients with hard lesions and pancreatic masses.

Figures

Figure 1
Figure 1
EUS-FNA images for pancreatic head cancer using (a) 22-gauge and (b) 25-gauge needles. The tip of the 22-gauge needle was bent within the lesion during the puncture, and no material was obtained. The arrow indicates the bent tip of the 22-gauge needle. The 25-gauge needle tip remained straight during the EUS-FNA procedure (arrow), and pancreatic adenocarcinoma was diagnosed with EUS-FNA using the 25-gauge needle.

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