Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis.
OBJECTIVE
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method to obtain specific diagnosis in various diseases. The optimal method of EUS-guided sampling of material for pathologic diagnosis has not been clearly established. The aim of our study was to compare two different techniques of EUS-guided sampling of solid masses, using either non-suction or suction with a 10-ml syringe.


METHODS
Patients assessed during a 6-month period were randomized to three passes of EUS-guided sampling with suction (26 patients) or non-suction (26 patients). The samples were characterized for cellularity and bloodiness, with a final cytology diagnosis established blindly. The final diagnosis was reached either by EUS-FNA if malignancy was definite, or by surgery and/or clinical follow-up of a minimum of 6 months in the cases of non-specific benign lesions.


RESULTS
EUS-guided fine-needle sampling with suction of solid masses increased the number of pathology slides (17.8+/-7.1 slides for suction as compared with 10.2+/-5.5 for non-suction, p=0.0001), without increasing the overall bloodiness of each sample. Sensitivity and the negative predictive values were higher when suction was applied, as compared to the non-suction group (85.7% as compared with 66.7%, p=0.05).


CONCLUSIONS
This prospective randomized study showed that EUS-guided fine-needle sampling of solid masses using suction yields a higher number of slides without increasing bloodiness. Although, the proportion of target cells was relatively similar between the suction and non-suction sampling techniques, the sensitivity and negative predictive values of the procedure were significantly higher when suction was added.
Puri
Rajesh
R
Department of Surgical Gastroenterology, Gentofte University Hospital, Hellerup, Denmark.
Vilmann
Peter
P
Săftoiu
Adrian
A
Skov
Birgit Guldhammer
BG
Linnemann
Dorte
D
Hassan
Hazem
H
Garcia
Elymir Soraya Galvis
ES
Gorunescu
Florin
F
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D015331:Cohort Studies; D004067:Digestive System Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013396:Suction; D025321:Surgery, Computer-Assisted