title: The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses.
abstract: OBJECTIVE
  A large-caliber needle such as a 19-gauge needle may help overcome the limitations of a 22-gauge needle by acquiring a larger amount of tissue sample. However, there has been no well-designed comparative study for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a 19-gauge aspiration needle. We conducted this study to compare the diagnostic accuracy of EUS-FNA using a 19-gauge aspiration needle with that using a 22-gauge aspiration needle in patients with solid pancreatic/peripancreatic mass.
  
  
  METHODS
  From March 2007 to April 2008, a total of 117 patients (60 in a 19-gauge needle group and 57 in a 22-gauge needle group) with solid pancreatic/peripancreatic mass were included. EUS-FNA was performed using the standard technique without an on-site cytopathologist. A single, blinded cytopathologist retrospectively evaluated each set of slides.
  
  
  RESULTS
  The diagnostic accuracy by intention-to-treat analysis was not significantly different (19G: 86.7% vs. 22G: 78.9%, P=0.268). However, the diagnostic accuracy by per-protocol analysis, excluding technical failures, was significantly higher in the 19-gauge needle group (94.5% vs. 78.9%, P=0.015). In the treatment-received group that included crossover cases, although the diagnostic accuracy in all cases was not significantly different (86.1% vs. 76.9%, P=0.164), that of body/tail lesion (95.0% vs. 76.7%, P=0.031) and technically successful cases (93.9% vs. 78.1%, P=0.006) were significantly higher in the 19-gauge needle group. On sample quality analysis, the amount of cellular material obtained was significantly higher in the 19-gauge needle group (P=0.033).
  
  
  CONCLUSIONS
  EUS-FNA with a 19-gauge aspiration needle may be a valuable method for the diagnosis of pancreatic/peripancreatic masses when an on-site cytopathologist is not available.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Jun Bum
authors.initials: JB
authors.lastname: Eum
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Moon
authors.forename: Do Hyun
authors.initials: DY
authors.lastname: Park
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Sung Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D044963:Biopsy, Fine-Needle / Q000295:instrumentation*; D016009:Chi-Square Distribution; D049448:Cholangiopancreatography, Magnetic Resonance; D003937:Diagnosis, Differential; D004724:Endoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional