title: The 25-gauge EUS-FNA needle: Good for on-site but poor for off-site evaluation? Results of a randomized trial.
abstract: BACKGROUND
  When on-site cytopathology support is not available, EUS-guided fine needle aspiration (EUS-FNA) is performed for cell-block preparation to allow off-site interpretation.
  
  
  OBJECTIVE
  To identify the number of passes required to obtain a diagnostic cell block by using a 25-gauge needle for sampling pancreatic masses.
  
  
  METHODS
  Randomized trial.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Sixty-two patients with solid pancreatic mass lesions.
  
  
  METHODS
  EUS-FNA was performed by using a 25-gauge needle. After establishing a preliminary on-site diagnosis, patients were randomized to 2 or 4 FNA passes for a cell block. A cell block was evaluated by a pathologist blinded to on-site interpretation for the presence of a tissue pellet, histological core tissue size, and diagnostic accuracy.
  
  
  METHODS
  To determine the number of passes required to obtain a diagnostic cell block with a 25-gauge FNA needle.
  
  
  RESULTS
  Sixty-two patients were randomized to undergo either 2 (n = 31) or 4 (n = 31) FNA passes for a cell block. Before randomization, an on-site diagnosis was established in all 62 patients (100%). The final diagnosis was adenocarcinoma in 45 (72.6%), neuroendocrine/other tumor in 7 (11.3%), and chronic pancreatitis in 10 (16.1%). There was no difference in the presence of a tissue pellet (93.5 vs 96.8%; P = .99), the median size of the histological core (0.006 vs 0.05 mm(2); P = .12), or the presence of a diagnostic cell block (80.6 vs 80.6%; P = .99) between patients randomized to 2 or 4 FNA passes, respectively.
  
  
  CONCLUSIONS
  Only pancreatic masses were evaluated.
  
  
  CONCLUSIONS
  The 25-gauge FNA needle yielded a diagnostic cell block in only 81% of patients, irrespective of whether 2 or 4 FNA passes were performed. These findings have important implications for centers without on-site cytopathology services. (Clinical trial registration number NCT01809028.).
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Shyam
authors: S
authors: Varadarajulu
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Ji Young
authors: JY
authors: Bang
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Bronte A
authors: BA
authors: Holt
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Muhammad K
authors: MK
authors: Hasan
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Amy
authors: A
authors: Logue
authors: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors: Robert H
authors: RH
authors: Hawes
authors: Department of Pathology, Florida Hospital, Orlando, Florida, USA.
authors: Shantel
authors: S
authors: Hebert-Magee
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D018358:Neuroendocrine Tumors / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000473:pathology*; D016037:Single-Blind Method; D013048:Specimen Handling / Q000379:methods