Clin Endosc.  2018 Nov;51(6):576-583. 10.5946/ce.2018.053.

Prospective Assessment of the Performance of a New Fine Needle Biopsy Device for EUS-Guided Sampling of Solid Lesions

• El Hajj II
• Wu H
• Reuss S
• Randolph M
• Harris A
• Gromski MA
• Al-Haddad

• KMID: 2430401
• DOI: http://doi.org/10.5946/ce.2018.053

Abstract

BACKGROUND/AIMS
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remains the most common EUS-guided tissue acquisition technique. This study aimed to evaluate the performance of a new Franseen tip fine needle biopsy (FNB) device for EUSguided sampling of solid lesions and compare it with the historical FNA technique.
METHODS
Acquire® 22 G FNB needle (Boston Scientific Co., Natick, MA, USA) was used for solid tumor sampling (Study group). Tissue was collected for rapid on-site evaluation, and touch and crush preparations were made. Historical EUS-FNA samples obtained using Expect® 22 G FNA needle (Boston Scientific Co.) were used as controls (Control group). All specimens were independently evaluated by two cytopathologists blinded to the formal cytopathological diagnosis.
RESULTS
Mean cell block histology scores were significantly higher (p=0.046) in the FNB group (51 samples) despite a significantly lower (p < 0.001) mean number of passes compared to the FNA group (50 specimens). The overall diagnostic yields for the FNB vs. FNA groups were 96% vs. 88%. The degree of tumor differentiation was adequately assessed in all cell block qualifying lesions in the FNB group. Two patients developed post-FNB abdominal pain.
CONCLUSIONS
The new Franseen tip FNB device provides histologically superior and cytologically comparable specimens to those obtained by FNA, but with fewer passes.

Keyword

Tissue acquisition; Endoscopic ultrasound-guided fine needle aspiration; Endoscopic ultrasound-guided fine needle biopsy

MeSH Terms

Abdominal Pain
Biopsy, Fine-Needle*
Diagnosis
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Humans
Needles
Prospective Studies*

Figure

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  Fig. 1. Pictures of the new Franseen tip fine needle biopsy (FNB) histology needle. (A) An image of the FNB needle. (B) Closer view of the tip of the FNB needle.

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  Fig. 2. Fine needle biopsy specimen obtained from a pancreatic head mass. This lesion was sampled using standard fine needle aspiration technique twice prior to referral to our hospital with insufficient cytology. Rare malignant cells seen infiltrating the fibrous stroma. This was assigned a score of 1 on the cell block. The final diagnosis was pancreatic adenocarcinoma (Hematoxylin and eosin, ×100).

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  Fig. 3. Fine needle biopsy specimen obtained from a pancreatic body mass. This was assigned a score of 2 on cell block. The final diagnosis was pancreatic adenocarcinoma (Hematoxylin and eosin, ×20).

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  Fig. 4. Fine needle biopsy specimen obtained from a mediastinal mass. This was assigned a score of 3 on cell block. The final diagnosis was poorly differentiated lung cancer (Hematoxylin and eosin, ×40).

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  Fig. 5. Fine needle aspiration specimen obtained from a liver mass. This was assigned a score of 3 on cell block. The final diagnosis was metastatic esophageal cancer (Hematoxylin and eosin, ×40).

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  Fig. 6. (A) Fine needle biopsy specimen obtained from a gastric subepithelial mass. Extensive bands of spindled cells with high cellularity are noted in this cell block. The final diagnosis of gastrointestinal stromal tumor was confirmed on c-Kit staining (Hematoxylin and eosin [H&E], ×40). (B) Fine needle aspiration specimen pulled from the archives from a gastric subepithelial mass of similar morphology and dimensions to the one presented in (A). Although this preparation is still diagnostic for gastrointestinal stromal tumor, substantially fewer groups of spindled cells are noted in this cell block (H&E, ×40).

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  Fig. 7. As opposed to the blood-tinged preservative solution with a clot on the bottom of the tube seen with standard fine needle aspiration cell blocks, fine needle biopsy blocks tend to be less bloody with several visible tan-colored tissue fragments (cores).

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  Fig. 8. A hematoma that developed between the gastric wall and the pancreatic neck after fine needle biopsy of a pancreatic body mass.

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