title: A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy.
abstract: OBJECTIVE
  Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses.
  
  
  METHODS
  Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy.
  
  
  RESULTS
  A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0 % vs. 67.1 %, P = 0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB: 91.7 % vs. FNA: 78.4 %, P = 0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2 % vs. 54.5 %, P = 0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (P = 0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5 %, P = 0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities.
  
  
  CONCLUSIONS
  RESULTS of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB.
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States.
authors.forename: A Aziz
authors.initials: AA
authors.lastname: Aadam
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Amick
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States.
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Bhat
authors.affiliation: Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Hamerski
authors.affiliation: Division of Gastroenterology, Moffitt Cancer Center, Tampa, Florida, United States.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Klapman
authors.affiliation: Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, United States.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
authors.affiliation: Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, United States.
authors.forename: Rabindra R
authors.initials: RR
authors.lastname: Watson
authors.affiliation: Department of Preventative Medicine, Northwestern University, Chicago, Illinois, United States.
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States.
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.affiliation: Arizona Digestive Health, Gilbert, Arizona, United States.
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri