An experimental study to assess the best maneuver when using a reverse side-bevel histology needle for EUS-guided fine-needle biopsy

A Meta-analysis of Slow Pull versus Suction for Endoscopic Ultrasound-Guided Tissue Acquisition

Background/Aims

Endoscopic ultrasound (EUS)-guided tissue acquisition is widely utilized as a diagnostic modality for intra-abdominal masses, but there remains debate regarding which suction technique, slow pull (SP) or conventional suction (CS), is better. A meta-analysis of reported studies was conducted to compare the diagnostic yields of SP and CS during EUS-guided tissue acquisition.

Methods

We conducted a systematic electronic search using MEDLINE/PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify clinical studies comparing SP and CS. We meta-analyzed accuracy, sensitivity, blood contamination and cellularity using the random-effects model.

Results

A total of 17 studies (seven randomized controlled trials, four prospective studies, and six retrospective studies) with 1,616 cases were included in the analysis. Compared to CS, there was a trend toward better accuracy (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.97 to 2.27; p=0.07) and sensitivity (OR, 1.67; 95% CI, 0.95 to 2.93; p=0.08) with SP and a significantly lower rate of blood contamination (OR, 0.48; 95% CI, 0.33 to 0.69; p<0.01). However, there was no significant difference in cellularity between SP and CS, with an OR of 1.28 (95% CI, 0.68 to 2.40; p=0.45). When the use of a 25-gauge needle was analyzed, the accuracy and sensitivity of SP were significantly better than those of CS, with ORs of 4.81 (95% CI, 1.99 to 11.62; p<0.01) and 4.69 (95% CI, 1.93 to 11.40; p<0.01), respectively.

Conclusions

Compared to CS, SP appears to provide better accuracy and sensitivity in EUS-guided tissue acquisition, especially when a 25-gauge needle is used.

"Clinical" cytology for endoscopists: A practical guide

Clinical cytology was originally used by clinicians to provide rapid diagnosis. However, with advancing medical subspecialization, few clinicians interpret cytology themselves these days, for example, gynecologists, hematologists, urologists, and occasional gastroenterologist (mainly in Asian countries). Cytological assessment enjoyed a renaissance with the development of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). Subsequently, pathologists, most of them more experienced in histology, had to take over. Recently, it has been shown that in-room cytology can be easily performed by the endoscopist themselves for initial evaluation of the quality of the EUS-FNA specimen and an initial diagnosis distinguishing benign or malignant cells. Bringing cytology back to the clinician has some advantages but does not substitute the professional cytopathologist. This report has written to lower the threshold for the clinician to find his way back to the microscope, which may improve both their diagnostic yield and assessment of EUS-FNA sample quality.

Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to obtain a definitive diagnosis of pancreatic tumors. Good results have been reported for its diagnostic accuracy, with high sensitivity and specificity of around 90%; however, technological developments and adaptations to improve it still further are currently underway. The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of EUS-FNA are known. This review provides various techniques and equipment for improvement in the diagnostic accuracy in EUS-FNA.