Clin Endosc.  2021 May;54(3):420-427. 10.5946/ce.2020.184.

Confirming Whether Fine Needle Biopsy Device Shortens the Learning Curve of Endoscopic Ultrasound-Guided Tissue Acquisition Without Rapid Onsite Evaluation

• Lin MY
• Wu CL
• Kida M
• Chang WL
• Sheu BS

• KMID: 2516323
• DOI: http://doi.org/10.5946/ce.2020.184

Abstract

Background/Aims
Endoscopic ultrasonography (EUS)-guided tissue acquisition requires a long learning curve. We aimed to compare the skill maturation curves between fine needle aspiration (FNA) and biopsy (FNB) for tissue acquisition.
Methods
The initial 60 procedures performed by the trainee endosonographer (30 FNA vs. 30 FNB) were consecutively enrolled. The difference in procedure performance was compared between the two groups. Learning curves were assessed. Twenty additional cases were subsequently enrolled to assess the consistency of performance in the FNB group.
Results
The FNB group acquired larger tissue samples (2.35 vs. 0.70 mm2; p<0.001) with lower blood content (p=0.001) and higher tissue quality (p=0.017) compared with the FNA group. In addition, the FNB group required less needle pass to establish a diagnosis (2.43 vs. 2.97; p=0.006). A threshold diagnostic sensitivity of ≥80% was achieved after performing 10 FNB procedures. The number of needle passes significantly decreased after conducting 20 FNB procedures (1.80 vs. 2.70; p=0.041). The diagnostic sensitivity and number of needle passes remained the same in the subsequent FNB procedures. By contrast, this skill maturation phenomenon was not observed after performing 30 FNA procedures.
Conclusions
In EUS-guided tissue acquisition, the FNB needle was more efficient and thus shortened the learning curve of EUSguided tissue acquisition in trainee endosonographers.

Keyword

Core needle biopsy; Endoscopic ultrasonography; Fine needle aspiration; Gastrointestinal endoscopes; Programmed learning

Figure

• 

  Fig. 1. Images of histological samples acquired using different types of needles (H&E stain, 100×). (A) Tissue samples acquired using an fine needle aspiration (FNA) needle contained large amounts of red blood cells with a small amount of tumor cells. (B) Tissue samples acquired using fine needle biopsy (FNB) needle contained tumor cells with a small amount of red blood cells.

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  Fig. 2. Evolutional change of the diagnostic sensitivity for malignant disease in chronological order with FNA and FNB needles. The dotted line represents the globally acceptable diagnostic sensitivity threshold of 80%. FNA, fine needle aspiration; FNB, fine needle biopsy.

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  Fig. 3. Comparison of needle pass number in chronological order between endoscopic ultrasound (EUS) FNA and EUS FNB. FNA group did not show a significant reduction in needle pass number with the increasing number of procedures. In the FNB group, the number of needle passes required in 21–30 procedures was significantly lesser than that in 1–10 or 11–20 procedures (*). In the validation step, the number of needle passes in 31–50 procedures was comparable to that in 21–30 procedures in the FNB group (†). Data were presented as mean ± SE. EUS, endoscopic ultrasound; FNA, fine needle aspiration; FNB, fine needle biopsy; SE, Standard Error.

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