title: Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses.
abstract: OBJECTIVE
  The aim of this prospective study was to compare fine-needle aspiration guided by endoscopic ultrasonography (EUS-FNA) using 25-gauge and 22-gauge needles with the EUS-guided 19-gauge Trucut needle biopsy (EUS-TNB) in patients with solid pancreatic mass.
  
  
  METHODS
  Twenty-four consecutive patients with pancreatic mass underwent biopsies by both EUS-FNA and EUS-TNB. Three needles were compared with respect to technical success rate, tissue size obtained, overall diagnostic accuracy and accuracy for histological and cytological diagnosis.
  
  
  RESULTS
  The 25-gauge EUS-FNA was technically easier and obtained superior overall diagnostic accuracy than the 22-gauge and Trucut needles, especially in lesions of the pancreas head and uncinate process. Overall accuracy for the 25-gauge, 22-gauge and Trucut needle was 91.7%, 79.7% and 54.1%, respectively. Accuracy for cytological diagnosis irrespective the site of lesions with 25-gauge, 22-gauge and Trucut needles was 91.7%, 75.0%, and 45.8%, respectively. For uncinate masses, it was 100%, 33.3%, and 0.0%, respectively. These differences were significant. Among technically successful patients, the accuracy for histological diagnosis using the 25-gauge was significantly inferior (P < 0.05) to 22-gauge and Trucut needles and the rates were 45.8%, 78.9% and 83.3%.
  
  
  CONCLUSIONS
  The 25-gauge FNA needle was significantly superior in terms of technical success rate and overall diagnostic accuracy, especially for the head and uncinate lesions, compared to the 22-gauge and Trucut needles and could be considered 'the best choice needle for cytological diagnosis' of solid pancreatic lesions. If histological diagnosis is required, the 22-gauge FNA needle and Trucut needle may be advantageous for use in head/uncinate and body/tail lesions, respectively.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Ohno-Higashi, Osaka-Sayama, Japan. hiroki.sakamoto@nifty.com
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Komaki
authors.forename: Kazu
authors.initials: K
authors.lastname: Noda
authors.forename: Takaaki
authors.initials: T
authors.lastname: Chikugo
authors.forename: Kensaku
authors.initials: K
authors.lastname: Dote
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takeyama
authors.forename: Kunal
authors.initials: K
authors.lastname: Das
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D006104:Granuloma, Plasma Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D009339:Needles; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional