Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2016; 22(39): 8790-8797
Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8790
Slow-pull and different conventional suction techniques in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid lesions using 22-gauge needles
Jia-Ying Chen, Qing-Yu Ding, Yang Lv, Wen Guo, Fa-Chao Zhi, Si-De Liu, Tian-Ming Cheng
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 Lv, Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong Province, China
Tian-Ming Cheng, Hui Qiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Chen JY and Cheng TM contributed equally to this work; Chen JY and Cheng TM designed the research, analyzed the data and drafted the manuscript; Ding QY and Lv Y collected the data; Guo W, Zhi FC and Liu SD revised the manuscript for important intellectual content; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Southern Medical University Institutional Review Board.
Informed consent statement: All patients in this study provided a signed informed consent statement.
Conflict-of-interest statement: Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Tian-Ming Cheng, Hui Qiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. chengtm@smu.edu.cn
Telephone: +86-020-61642261 Fax: +86-020-61642494
Received: August 22, 2016
Peer-review started: August 23, 2016
First decision: September 12, 2016
Revised: September 19, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: October 21, 2016
Abstract
AIM

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% vs 63.2% vs 58.8% vs 55.6%, P = 0.019), sensitivity (88.2% vs 41.7% vs 40.0% vs 36.4%, P = 0.009) and blood contamination (score ≥ 2 for 29.0% vs 52.6% vs 70.6% vs 72.2%, 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).

CONCLUSION

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.

Keywords: Endoscopic ultrasound-guided fine-needle aspiration, Pancreatic solid lesion, Slow-pull technique, Suction, Negative pressure, Cytology

Core tip: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an essential technique for obtaining tissue diagnoses for pancreatic masses, and application of suction is one of the potential influencing factors of EUS-FNA. The slow-pull technique has recently emerged as a new sampling technique in EUS-FNA of pancreatic masses. We found that the slow-pull technique using 22-gauge needles may increase the cytological diagnostic accuracy and sensitivity and result in only slight blood contamination in EUS-FNA of pancreatic solid lesions.