Slow-pull and different conventional suction techniques in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid lesions using 22-gauge needles.
OBJECTIVE
To evaluate the cytological diagnostic capacity and sample quality of the slow-pull technique and compare them with different suction techniques.


METHODS
From July 2010 to December 2015, 102 patients with pancreatic solid lesions who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with 22-gauge needles were retrospectively evaluated. EUS-FNA diagnosis was based on a cytological examination, and final diagnosis was based on a comprehensive standard of cytological diagnosis, surgical pathology and clinical or imaging follow-up. Cytological specimens were characterized for cellularity and blood contamination. The cytological diagnostic capacity and sample quality of the slow-pull technique and suction techniques with 5-mL/10-mL/20-mL syringes were analyzed.


RESULTS
Of all of the EUS-FNA procedures, the slow-pull technique and suction techniques with 5-mL/10-mL/20-mL syringes were used in 31, 19, 34 and 18 procedures, respectively. There were significant differences between these four suction techniques in terms of cytological diagnostic accuracy (90.3%vs63.2%vs58.8%vs55.6%,P= 0.019), sensitivity (88.2%vs41.7%vs40.0%vs36.4%,P= 0.009) and blood contamination (score ≥ 2 for 29.0%vs52.6%vs70.6%vs72.2%,P= 0.003). The accuracy and sensitivity of the slow-pull technique were significantly higher than those of the suction techniques using 5-mL (P= 0.03,P= 0.014), 10-mL (P= 0.005;P= 0.006) and 20-mL syringes (P= 0.01,P= 0.01). Blood contamination was significantly lower in the slow-pull technique than in the suction techniques with 10-mL (P= 0.001) and 20-mL syringes (P= 0.007).


CONCLUSIONS
The slow-pull technique may increase the cytological diagnostic accuracy and sensitivity with slight blood contamination during EUS-FNA when using 22-gauge needles for solid pancreatic masses.
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Jia-Ying
JY
Chen
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Qing-Yu
QY
Ding
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Yang
Y
Lv
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Wen
W
Guo
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Fa-Chao
FC
Zhi
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Si-De
SD
Liu
Jia-Ying Chen, Qing-Yu Ding, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Tian-Ming
TM
Cheng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013396:Suction / Q000295:instrumentation* / Q000379:methods*; D055815:Young Adult
Cytology; Endoscopic ultrasound-guided fine-needle aspiration; Negative pressure; Pancreatic solid lesion; Slow-pull technique; Suction