Post written by Priscilla A. van Riet, MD, from the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.

Our study focused on the optimization of EUS-guided tissue sampling. For this, we compared the diagnostic performance of a newly designed FNB needle, the 20G ProCore needle with a forward-facing bevel, to a commonly used, more conventional, small caliber, flexible 25G FNA needle with a standard bevel, in terms of diagnostic accuracy, histological yield, and safety.

As the role of EUS-guided tissue acquisition is expanding in this era of personalized medicine, identification of the optimal sampling device is becoming increasingly important. Although several studies have compared several EUS-FNA and FNB needles, the optimal needle type and size has not been identified.

Our results demonstrate that the large bore 20G FNB needle (ProCore design) out-performed one of the most widely used 25G FNA needles (EchoTip Ultra design), in terms of histological yield and diagnostic accuracy, in pancreatic as well as non-pancreatic lesions. This was independent of the number of passes performed. Safety was equally good for the 2 needles. The fact that our study results were consistent among 13 international EUS centers supports the general applicability of our findings. Traditionally, FNA needles are known for their flexibility, while FNB needles are designed to collect larger samples, specifically histology. However, which benefit outweighs the other is not known. Previous studies did show that flexible needles tend to outperform the traditional large and stiffer FNB needles, such as the 19G FNB or Trucut needle, which mainly results from their inability to sample lesions from an angulated scope position. However, what has not been shown before is that combining flexibility with a large diameter can result in a higher diagnostic yield as compared to a flexible FNA needle, due to an improved technical success rate. Despite of the favorable performance of the 20G ProCore FNB needle in the current study, it should be noted that there are a number of other new EUS-FNA and FNB needles available, most were designed to improve the histological yield. Future studies should continue to compare EUS needles, but only those with distinguished design features, to find the optimal needle for a personalized medical approach.

Figure 1. Needle tip design and dimensions of the 20-gauge fine-needle biopsy needle with a forward-facing bevel and a Menghini tip design.

Although FNA and FNB are often referred to as 2distinctive entities, this seems somewhat artificial. Also, with FNA needles histological samples can be retrieved. It is therefore more accurate to regard them as complementary in the sense that depending on specific design features of the needle the chance to harvest core tissue varies.

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