title: Comparison of EUS-guided tissue acquisition using two different 19-gauge core biopsy needles: a multicenter, prospective, randomized, and blinded study.
abstract: OBJECTIVE
  The optimal core biopsy needle for endoscopic ultrasound (EUS) is unknown. The principle aim of this study is to compare outcomes of EUS-fine-needle biopsy (EUS-FNB) with a new 19-gauge EUS histology needle (ProCore, Cook Medical Inc., Winston-Salem, North Carolina, United States) to a conventional 19-gauge Tru-Cut biopsy (EUS-TCB) needle (19G, Quick-Core, Cook Medical Inc.).
  
  
  METHODS
  Patients referred for EUS who require possible histologic biopsy were prospectively randomized to EUS-FNB or EUS-TCB. With the initial needle, ≤ 3 biopsies were obtained until either technical failure or an adequate core was obtained. Patients with suspected inadequate biopsies were crossed over to the other needle and similarly ≤ 3 passes were obtained until adequate cores or technical failure occurred. Technical success, diagnostic histology, accuracy and complication rates were evaluated.
  
  
  RESULTS
  Eighty-five patients (mean 58 years; 43 male) were randomized to FNB (n = 44) and TCB (n = 41) with seven patients excluded. Procedure indication, biopsy site, mass size, number of passes, puncture site, overall technical success and adverse events were similar between the two groups. FNB specimens had a higher prevalence of diagnostic histology (85 % vs. 57 %; P = 0.006), accuracy (88 % vs. 62 %; P = 0.02), mean total length (19.4 vs. 4.3 mm; P = 0.001), mean complete portal triads from liver biopsies (10.4 vs. 1.3; P = 0.0004) and required fewer crossover biopsies compared to those of TCB (2 % vs. 65 %; P = 0.0001). Overall technical success and complication rates were comparable.
  
  
  CONCLUSIONS
  EUS-FNB using a 19-gauge FNB needle is superior to 19-gauge EUS-TCB needle.
authors.affiliation: Department of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
authors.affiliation: Department of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Cho
authors.affiliation: Department of Pathology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.
authors.forename: Jingmei
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, United States.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Haddad
authors.affiliation: Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.affiliation: Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Salamone
authors.affiliation: The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.affiliation: Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Messallam
authors.affiliation: Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab