title: Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study.
abstract: OBJECTIVE
  A new core biopsy needle for endoscopic ultrasound (EUS)-guided sampling has recently been developed. The aim of this prospective multicenter study was to compare this needle with a standard needle in patients with solid pancreatic masses.
  
  
  METHODS
  Consecutive patients with solid pancreatic masses referred to 17 centers for EUS-guided sampling were included. Each patient had two passes with a standard 22G needle and a single pass with a 22G core needle performed in a randomized order. Samples from both needles were separately processed for liquid-based cytology and cell-block preparation and were assessed independently by two blinded expert pathologists. The primary endpoint was the accuracy of the detection of malignancy. The reference standard was based on further cytohistological analysis obtained under ultrasound or computed tomography scanning, endoscopic or surgical guidance, and/or by clinical follow-up with repeated imaging examinations for at least 12 months. The secondary endpoints were the rate of technical failure and the quality of the cytohistological samples obtained.
  
  
  RESULTS
  Of the 80 patients included (49 men; mean age 67.1 ± 11.1), 87.5 % had final malignant diagnoses (adenocarcinoma n = 62, 77.5 %). There was no difference between the needles in diagnostic accuracy (standard needle 92.5 % vs. core needle 90 %; P = 0.68) or technical failure. Both pathologists found the overall sample quality significantly better for the standard needle (expert 1, P = 0.009; expert 2, P = 0.002).
  
  
  CONCLUSIONS
  The diagnostic accuracy of EUS sampling for solid pancreatic masses using standard and core needles seems comparable but with a better overall histological sample quality for the former. ClinicalTrial.gov identifier: NCT01479803.
authors.affiliation: Université de Nice Sophia Antipolis, Faculté de Médecine and Centre Hospitalier Universitaire de l'Archet 2, Pôle digestif, Nice, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: Hôpital Privé Mermoz, Gastroentérologie, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Napoléon
authors.affiliation: Centre Hospitalier Universitaire Pasteur, Anatomopathologie, Nice, France.
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Saint Paul
authors.affiliation: Centre Hospitalier Universitaire Cimiez, Département de la recherche clinique, Nice, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sakarovitch
authors.affiliation: Centre Hospitalier Universitaire de Poitiers, Gastroentérologie, Poitiers, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Wangermez
authors.affiliation: Hôpitaux Universitaires de Genève, Gastroentérologie, Genève, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bichard
authors.affiliation: Centre hospitalier Universitaire du Haut-Lévêque, Gastroentérologie, Pessac, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Subtil
authors.affiliation: Centre hospitalier Universitaire de Besançon, Gastroentérologie, Besançon, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Koch
authors.affiliation: Assistance publique des hôpitaux de Marseille, Hôpital de la Timone, Gastroentérologie, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Grandval
authors.affiliation: Hospices civils de Lyon, Gastroentérologie, Lyon, France.
authors.forename: Rodica
authors.initials: R
authors.lastname: Gincul
authors.affiliation: Clinique de Bercy, Pôle digestif, Charenton le Pont, France.
authors.forename: David
authors.initials: D
authors.lastname: Karsenti
authors.affiliation: Assistance publique des hôpitaux de Marseille, Hôpital de la Conception, Gastroentérologie, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Heyries
authors.affiliation: Centre Hospitalier Général de Compiègne, Gastroentérologie, Compiègne, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Duchmann
authors.affiliation: Centre Hospitalier Universitaire Carémeau, Gastroentérologie, Nîmes, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Bourgaux
authors.affiliation: Assistance Publique des hôpitaux de Paris, Hôpital Mondor, Gastroentérologie, Créteil, France.
authors.forename: Michaël
authors.initials: M
authors.lastname: Levy
authors.affiliation: Centre Hospitalier Universitaire de la Cavale Blanche, Gastroentérologie, Brest, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Calament
authors.affiliation: Hôpital Privé Mermoz, Gastroentérologie, Lyon, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Fumex
authors.affiliation: Hôpital Privé Mermoz, Gastroentérologie, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Pujol
authors.affiliation: Hôpital Privé Mermoz, Gastroentérologie, Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lefort
authors.affiliation: Centre Hospitalier Universitaire Estaing, Gastroentérologie, Clermont Ferrand, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Poincloux
authors.affiliation: Centre Hospitalier Universitaire de Pontchaillou, Gastroentérologie, Rennes, France.
authors.forename: Maël
authors.initials: M
authors.lastname: Pagenault
authors.affiliation: Assistance publique des hôpitaux de Marseille, Hôpital Nord, Gastroentérologie, Marseille, France.
authors.forename: Eduardo Aimé
authors.initials: EA
authors.lastname: Bonin
authors.affiliation: Gustave Roussy, Pathologie Morphologique, Villejuif, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Fabre
authors.affiliation: Assistance publique des hôpitaux de Marseille, Hôpital Nord, Gastroentérologie, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000295:instrumentation*; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011446:Prospective Studies