Study On Several Related Factors Of Endoscopic Ultrasound-guided Fine Needle Aspiration For Solid Pancreatic Lesions

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Comparison of Smear Cytology and Liquid-based Cytology in Endoscopic Ultrasound-guided Fine Needle Aspiration of Pancreatic LesionBackground and aims: The studies comparing the diagnostic efficacy of liquid-based cytology(LBC)and smear cytology(SC)of pancreatic tissue sampling obtained via endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)are still insufficient.Current results are controversial.We compared the diagnostic efficiency of LBC and SC of pancreatic lesions using EUS-FNA in one of the largest tertiary hospitals in China.Methods: A retrospective database search(Jan 2015 to Jan 2019)was performed for patients who underwent EUS-FNA with both LBC and SC.Demographic,cytological and endosonographic data were collected from 819 patients.514 cases met the inclusion criteria.Diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)were compared.Rapid on-site evaluation(ROSE)were not available in all cases.Results: 385 cases(74.90%)confirmed with malignancy,40 cases(7.78%)confirmed benign neoplasm.Adequate tissue sampling rates showed no significant difference between the 2 groups.The sensitivity,accuracy and NPV of LBC were higher than those of SC with statistical significance(71.4% versus 55.1%,76.1% versus 61.6%,40.6% versus 27.7%respectively).The sensitivity,accuracy and NPV of combined SC and LBC were higher than those of LBC alone with statistical significance(83.9% versus 71.4%,86.5% versus76.1%,56.8% versus 40.6% respectively).Multivariate analysis revealed that pancreatic neck/body/tail lesions(P=0.003),solid lesions(P<0.001),needle size of 22-guage(P<0.001),and number of needle passage>3(P=0.041)were associated with higher diagnostic sensitivity in all participants using LBC,while number of needle passage>3(P=0.017)was associated with higher diagnostic sensitivity using SC.Conclusions: LBC was more accurate and sensitive than SC in EUS-FNA of pancreatic lesion with higher NPV,when ROSE is unavailable.Pancreatic neck/body/tail lesions,solid lesions,22-gauge needle and more than 3 passes are associated with higher sensitivity when using LBC.As for SC,more than 3 passes is associated with higher sensitivity.2.Optimal Number of Needle Passes During Endoscopic Ultrasound-guided Fine Needle Biopsy of Solid Pancreatic Lesions with22 G Pro Core Needles and Different Suction Techniques: a Randomized Controlled TrialBackground and aims: The sensitivity of endoscopic ultrasound-guided fine needle biopsy(EUS-FNB)varies considerably.The optimal number of passes through a solid pancreatic lesion with a 22 G FNB needle during EUS-FNB is controversial.This prospective randomized controlled study aimed to determine the optimal number of needle passes during EUS-FNB of solid pancreatic lesions,with 22 GFNB needles and different sampling techniques.Methods: Pancreatic masses were sampled using 22 G FNB needles with either the stylet slow-pull(SP)technique or the standard-suction(SS)technique.We determined the number of needle passes required to obtain a diagnostic accuracy of >90%.Differences between the two techniques in terms of technical success rate,cytological acquisition,core-tissue acquisition,sensitivity,specificity,accuracy,positive predictive value,negative predictive value,and complications were analyzed.Results: A total of 120 patients were randomly assigned to either SP or SS group.Three patients who were lost to follow-up and one who did not complete 5 passes due to bent needle head were excluded from the study.56 cases in the SP group and 60 cases in the SS group were included in the analysis.For SP technique,the cumulative accuracy of passes 1,2,3,4,and 5 were 44.83%,76.79%,87.50%,92.86%,and 94.64%,respectively.For SS technique,the cumulative accuracy of passes 1,2,3,4,and 5 were 71.67%,85.0%,90.0%,93.33%,and 95.0%,respectively.For each group,there was no statistically significant difference in accuracy after 3 and 4 passes.After 4 passes,the pooled sensitivity(92.59% vs.93.10%),accuracy(92.86% vs.93.10%),and specificity(100%vs.100%)were similar(p>0.05)in the SP and SS groups,respectively.In addition,positive cytological diagnoses(83.9% vs.85.0%),and positive histological diagnoses(71.4% vs.78.3%)were comparable(p>0.05)in the SP and SS groups,respectively.No statistically significant factor was found associated with diagnostic sensitivity for each group.Conclusion: When on-site cytological evaluation is unavailable,we recommend that at least 3 passes with 22 G Pro Core needles be performed during EUS-FNB using the SStechnique,at least 4 passes when using SP technique.The SS technique showed potential advantages over SP technique in tissue acquisition and diagnostic capabilities.3.Comparison of Diagnostic Efficacy of Endoscopic Ultrasound-guided Fine Needle Biopsy for Solid Pancreatic Lesions with Three Suction TechniquesBackground and aims: There are few studies focusing on the diagnostic efficacy of EUS-FNB by different suction techniques so far.Further studies are needed to clarify whether the research results on the diagnostic efficacy of FNA needle can be deduced into FNB.In this study,EUS-FNB was applied for the solid pancreatic lesions using three common suction techniques,and the diagnostic efficacy of these techniques were compared.Methods: EUS-FNB was performed for solid pancreatic lesions by 25 G Pro Core needle using 10 m L negative pressure,slow-pull and wet suction techniques in a randomized order with cross-over design.The difference between the three techniques in diagnostic accuracy,sensitivity,specificity,PPV,NPV,complication rate,of sample acquisition rate were compared.Results: By the end of October 2019,a total of 93 cases had been enrolled,of which90 were diagnosed as malignant and 3 as benign.There was no significant difference in histology,liquid-based cytology and smear cytology sample adequacy rate among the samples obtained by the three suction techniques.10 m L negative pressure technique was superior to wet suction technique and slow-pull technique in terms of diagnostic accuracy,sensitivity and NPV without statistical significance.The smears prepared by the sampled obtained by 10 m L negative pressure and slow-pull was superior to the wet suction in terms of blood contamination.There was no significant difference in diagnostic ability between histological,liquid-based and smear cytological results.Logistic regression analysis found no influential factors related to the diagnostic sensitivity of the three suction techniques.Conclusions: There was no significant difference in diagnostic sensitivity,specificity,accuracy,PPV and NPV between the three suction techniques when performing EUS-FNB for solid pancreatic lesions using 25 G Pro Core needle.However,there is a potential advantage of diagnostic efficiency for 10 m L negative pressure technique over the other two techniques.