title: Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses.
abstract: BACKGROUND
  Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic masses is an established procedure for obtaining a pathological specimen. However, application of suction during EUS-FNA is still controversial and the efficacy of the slow-pull technique was recently reported for new core biopsy needles.
  
  
  OBJECTIVE
  The purpose of this study was to compare the suction and slow-pull techniques using regular FNA needles.
  
  
  METHODS
  The diagnostic yield of the suction and slow-pull techniques was retrospectively studied for patients who underwent EUS-FNA for pancreatic solid lesions.
  
  
  RESULTS
  A total of 367 passes (181 by suction and 186 by the slow-pull technique) were performed during 97 EUS-FNA procedures for 93 patients with pancreatic solid lesions. The slow-pull technique resulted in lower scores for cellularity (≥2 for 37.5 % vs. 76.7 %) but scores for contamination with blood were lower (≥2 for 25.0 % vs. 66.7 %) and sensitivity of diagnosis of malignancy was higher (90.0 % vs. 67.9 %) when a 25-gauge FNA needle was used. There were no significant differences between the two techniques when a 22-gauge needle was used. In multivariate analysis of 82 cases with malignancy, the slow-pull technique (odds ratio (OR) 1.92, P = 0.028), tumor size ≥25 mm (OR 4.64, P < 0.001), and tumor location in the body or tail (OR 2.82, P < 0.001) were associated with greater sensitivity.
  
  
  CONCLUSIONS
  The slow-pull technique was associated with less contamination with blood and can potentially increase the diagnostic yield compared with the suction technique in EUS-FNA of pancreatic solid masses, especially with a 25-gauge FNA needle.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Chang
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Rie
authors.initials: R
authors.lastname: Uchino
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.forename: Koji
authors.initials: K
authors.lastname: Miyabayashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Mariko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D002828:Choristoma / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009339:Needles; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging / Q000473:pathology; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen; D013396:Suction