Post written by Mehdi Mohamadnejad, MD, from the Liver and Pancreatobilliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

This randomized trial compared per-pass performance of 2 types of fine-needle biopsy (FNB) needles for the detection of malignancy in solid pancreatobiliary mass lesions.

In these lesions, the optimal number of passes of EUS-guided FNB sampling (EUS-FNB) required to detect malignancy is unknown. An FNB needle from Microtech (Nanjing, China) recently became commercially available. This needle has 3 asymmetrical prongs in which 1 tip is longer than the other 2. The performance of this needle in detecting malignancy in pancreatobiliary masses is unknown.

In this study, per-pass performance of an FNB needle with a 3-prong asymmetric tip was compared with the Franseen needle (Acquire; Boston Scientific Corporation, Marlborough, Mass, USA) that has 3 symmetrical prongs.

There was no significant difference in the diagnostic performance of the Franseen needle versus the 3-prong asymmetric-tip needle in patients with suspected pancreatobiliary cancer. However, the Franseen needle yielded higher cellularity of the specimen.

In the Franseen needle group, the cumulative sensitivity for diagnosing malignancy was 85.1% (95% confidence interval [CI], 77.7-93.8) for pass 1 and increased to 91.5% (95% CI, 79.6-97.6) for pass 2 and 93.6% (95% CI, 82.5-98.6) for pass 3, with no improvement in sensitivity for pass 4.

In the 3-prong asymmetric-tip needle arm, the cumulative sensitivity was 82.4% (95% CI, 69.1-91.6) for pass 1, increased to 90.2% (95% CI, 78.6-96.7) for pass 2 and 96.1% (95% CI, 89.5-99.5) for pass 3, and finally rose to 98% (95% CI, 89.6-99.9) for pass 4.

Based on these findings, we recommend that 2 to 3 passes of FNB are taken during EUS-FNB of pancreatobiliary mass lesions to reach an acceptable sensitivity to detect malignancy.

Cumulative sensitivity of EUS-guided fine-needle biopsy sampling with each pass in 2 types of fine-needle biopsy needles. CI, Confidence interval.

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