Post written by Stefano Francesco Crinò, MD, from the Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy.

Different needles for EUS-guided fine-needle biopsy (EUS-FNB) are currently available. Side-fenestrated and end-cutting types are both widespread and available in different calibers.

This is the first randomized study directly comparing the performance of these 2 needles for the evaluation of solid pancreatic lesions. The primary endpoint was histological procurement yield.

Availability of tissue samples for histological examination represents a breakthrough in the evaluation of pancreatic masses. As compared with cytology smears, histological specimens are easier to interpret by the majority of pathologists, enable the performance of numerous immunohistochemical stainings needed to accurately define rare diseases, and provide higher rates of specimens adequate for molecular diagnostics as demonstrated by recent randomized trials. Therefore, to assess which FNB needle could improve histological yield in clinical practice is of paramount importance.

Our study demonstrated that fork-tip needles outperformed the same caliber side-fenestrated ones in terms of histological yield and sample quality, with similar safety profiles. Moreover, diagnostic accuracy was slightly higher in the fork-tip group, with a lower number of passes.

Future comparative studies should focus on the feasibility of molecular diagnostics, but also evaluation of the stromal component and immunological factors, on samples collected with different needle types and various sampling techniques, and assess the minimum quantity of tissue necessary to perform such analyses.

The single-center design and academic setting of our study could affect result reproducibility in community hospitals. Moreover, we included only solid pancreatic tumors and our findings might be different in non-pancreatic lesions.

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