Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy.
BACKGROUND
EUS-guided fiducial placement facilitates image-guided radiation therapy (IGRT).


OBJECTIVE
To compare 2 types of commercially available fiducials for technical success, complications, visibility, and migration.


METHODS
Retrospective, single-center, comparative study.


METHODS
Tertiary-care medical center.


METHODS
Traditional fiducials (TFs) (5-mm length, 0.8-mm diameter) and Visicoil fiducials (VFs) (10-mm length, 0.35-mm diameter) were compared. Fiducials were placed using linear 19-gauge (for TFs) or 22-gauge (for VFs) needles. A subjective visualization scoring system (0-2; 0 = not visible, 1 = barely visible, 2 = clearly visible) was used to assess visibility on CT. Fiducial migration was calculated as a change in interfiducial distance.


METHODS
Technical success, complications, visibility, and migration of 2 types of fiducials.


RESULTS
Thirty-nine patients with locally advanced pancreatic cancer underwent EUS-guided placement of 103 fiducials (77 TFs, 26 VFs). The mean number of fiducials placed per patient was 2.66 (standard deviation 0.67) for the 19-gauge needle and 2.60 (standard deviation 0.70) for the 22-gauge needle (P = .83). No intra- or postprocedural complications were encountered. The median visibility score for TFs was significantly better than that for VFs, both when scores of 0 were and were not included (2.00, interquartile range [IQR] 2.00-2.00 vs 1.75, IQR 1.50-2.00, P = .009 and 2.00, IQR 2.00-2.00 vs 2.00, IQR 1.50-2.00, P < .0001, respectively). The mean migration was not significantly different between the 2 types of fiducials (0.8 mm [IQR 0.4-1.6 mm] for TFs vs 1.3 mm [IQR 0.6-1.5 mm] for VFs; P = .72).


CONCLUSIONS
Retrospective, nonrandomized design.


CONCLUSIONS
Visibility was significantly better for TFs compared with VFs. The degree of fiducial migration was not significantly different for TFs and VFs. There was no significant difference in the mean number of fiducials placed, indicating a similar degree of technical difficulty for TF and VF deployment.
Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA.
Mouen A
MA
Khashab
Katherine J
KJ
Kim
Erik J
EJ
Tryggestad
Aaron T
AT
Wild
Teboh
T
Roland
Vikesh K
VK
Singh
Anne Marie
AM
Lennon
Eun Ji
EJ
Shin
Mark A
MA
Ziegler
Reem Z
RZ
Sharaiha
Marcia Irene
MI
Canto
Joseph M
JM
Herman
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D057918:Fiducial Markers / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016634:Radiosurgery / Q000295:instrumentation*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional