"Wet suction technique (WEST)": a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions.
BACKGROUND
Contemporary EUS-guided FNA techniques involve the use of a needle, with an air column within the lumen, with or without suction. We describe a novel technique with an aim to improve the quality of the aspirate.


OBJECTIVE
To compare a novel "wet suction" technique (WEST) with the conventional FNA technique (CFNAT) of EUS-guided FNA using a 22-gauge FNA needle.


METHODS
Prospective, single-blind, and randomized trial.


METHODS
Two large tertiary-care hospitals.


METHODS
All consecutive adult patients presenting for EUS with possible FNA of solid lesions were offered the chance to participate in the study.


METHODS
All lesions were sampled with the same needle by using alternating techniques. Patients were randomized to the WEST versus the CFNAT for the first pass. If the first pass was made with the WEST, the second pass was made with the CFNAT, and subsequent passes were made in an alternating manner by using the same sequence. All FNAs were performed using 22-gauge needles.


METHODS
Specimen adequacy, cellularity, and blood contamination of EUS-guided FNA aspirates graded on a predefined scale.


RESULTS
The WEST yielded significantly higher cellularity in a cell block compared with the CFNAT, with a mean cellularity score of 1.82±0.76 versus 1.45±0.768 (P<.0003). The WEST cell block resulted in a significantly better specimen adequacy of 85.5% versus 75.2% (P<.035). There was no difference in the amount of blood contamination between the 2 techniques.


CONCLUSIONS
Lack of cross check and grading by a second cytopathologist.


CONCLUSIONS
The novel WEST resulted in significantly better cellularity and specimen adequacy in cell blocks of EUS-guided FNA aspirate of solid lesions than the CFNAT.
Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota.
Rajeev
R
Attam
Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota.
Mustafa A
MA
Arain
Division of Cytopathology, University of Minnesota, Minneapolis, Minnesota.
Stephen J
SJ
Bloechl
Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota.
Guru
G
Trikudanathan
Washington University, St. Louis, Missouri.
Satish
S
Munigala
Division of Gastroenterology, VA Medical Center, Minneapolis, Minnesota.
Yan
Y
Bakman
Patient Centered Research, Aurora Health Care, Milwaukee, Wisconsin, USA.
Maharaj
M
Singh
Department of Pathology, Aurora Health Care, Milwaukee, Wisconsin, USA.
Timothy
T
Wallace
Department of Gastroenterology, Aurora Health Care, Milwaukee, Wisconsin, USA.
Joseph B
JB
Henderson
Department of Gastroenterology, Aurora Health Care, Milwaukee, Wisconsin, USA.
Marc F
MF
Catalano
Department of Gastroenterology, Aurora Health Care, Milwaukee, Wisconsin, USA.
Nalini M
NM
Guda
D000328:Adult; D000368:Aged; D004067:Digestive System Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D060787:Neoplasm Grading; D011446:Prospective Studies; D016037:Single-Blind Method; D013396:Suction / Q000379:methods*