Post written by Pujan Kandel, MD, from the Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida.
This was a single center retrospective case control study. All the consecutive samples from EUS-FNB-SCs were matched in a 1:3 ratio by the lesion site (e.g. pancreatic head) and needle gauge (i.e. 19, 22, and 25 gauge) to recent random samples of EUS-FNA. The main aim of our study was to compare the histology yield of EUS-FNB sampling using the Shark Core needle (EUS-FNB-SC) to EUS-FNA in patients who had solid pancreatic and nonpancreatic lesions.
Several retrospective studies, prospective studies, and randomized controlled trials have failed to demonstrate the significant difference in diagnostic adequacy between second generation FNB needles and conventional FNA needles. True histology is important for lymphoma, GI stromal tumor, and autoimmune pancreatitis. The tip of the Shark core needle (FNB-SC) has a second sharp tip on the opposite side of the lumen designed to improve the tissue acquisition (Fig. 1). As the use of molecular studies on tissue samples for gene-specific oncologic therapy have been rising, true histology is vital rather than cytology alone. In addition, in the growing field of precision medicine, larger tissue volume is important for DNA yield and the ability to perform genomic analysis of pancreatic tissue. Also, the use of FNB needle with fewer number of passes for tissue acquisition is effective in saving the cost associated with procedure by decreasing the anesthesia time.
Results of our study have shown that a newly designed, forked-tip FNB needle provided higher yield of tissue core with fewer number of passes compared to standard FNA needles (95% vs 59%, P=0.01) (Table 1). FNB-SC needles required significantly fewer number of passes to obtain tissue samples (median FNB-SC, 2 passes vs FNA, 4 passes; P=0.01) compared to FNA needles (Table 2). These differences remained significant for all lesion sites and gauges. No adverse events were reported. The higher histology yield of FNB-SC needle is similar to the Trucut biopsy (EUS-TNB) needle used by Gerke et al for tissue acquisition. The results for this preliminary needle suggest that EUS-FNB-SC may be better for tissue acquisition than FNA-needles for histopathological evaluation. Larger prospective randomized comparative trials are needed to confirm these findings.
This new generation novel fork tip needle may help in minimizing the cost of procedure and increase the diagnostic accuracy. Higher histology yield and intact core tissue is important for precision therapy in future research.
Figure 1. Detailed pictures of the tip of the new FNB-SC histology needle. A, An image of Shark-Core biopsy needle with a second tip at opposite side for tissue capture during punture. B, Closer view of second tip of Shark-Core biopsy needle. C, Shark-Core biopsy needle tip.
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