title: The slow-pull capillary technique increases the quality of endoscopic ultrasound fine needle biopsy samples in solid pancreatic lesions.
abstract: BACKGROUND
  Endoscopic ultrasound-guided sampling is used routinely for the diagnosis of solid pancreatic masses. We aimed to compare the standard suction technique with the recently described 'slow-pull' technique.
  
  
  METHODS
  Patients with a solid pancreatic mass of more than 2 cm undergoing endoscopic ultrasound-guided fine needle biopsy with the same endoscopist using a 22 G core biopsy needle were included in the study. Patients had a first suction pass, followed by either another suction pass or a slow-pull pass. The rate of samples contributive to the diagnosis, cellularity, presence of tissue microfragments, and blood contamination were assessed and compared between each pass and each technique.
  
  
  RESULTS
  A total of 98 patients with a lesion diameter of 33.1±10 mm were analyzed. Lesions were adenocarcinomas in 83%, neuroendocrine tumors in 6%, and benign lesions in 11% of the cases. The rate of contributive samples of the first suction pass, the slow-pull pass, and the second suction pass were 96.9, 97.9, and 90.2%, respectively (P=NS). The slow-pull capillary technique, compared with the suction technique, provided samples with better cellularity, higher proportion of representative and tumor cells, and more tissue microfragments (P=0.002, 0.0004, 0.006, and 0.005, respectively).
  
  
  CONCLUSIONS
  Endoscopic ultrasound-guided fine needle biopsy sampling of solid pancreatic lesions using the slow-pull technique yielded overall outcomes similar to the standard suction technique in terms of diagnostic performance. However, the slow-pull capillary technique improved the histological quality of the samples, mainly through a higher proportion of tissue microfragments and tumor cells.
authors.affiliation: Departments of aGastroenterology bPathology cBiostatistics and Epidemiology, Cochin Hospital, Assistance Publique - Hopitaux de Paris dSchool of Medicine, Paris Descartes University, Paris, France.
authors.forename: Rana
authors.initials: R
authors.lastname: El Haddad
authors.forename: Maximilien
authors.initials: M
authors.lastname: Barret
authors.forename: Frédéric
authors.initials: F
authors.lastname: Beuvon
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
authors.forename: Sarah
authors.initials: S
authors.lastname: Leblanc
authors.forename: Benoit
authors.initials: B
authors.lastname: Terris
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.forename: Frédéric
authors.initials: F
authors.lastname: Prat
mesh_terms: 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; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D047368:Tumor Burden