Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8790
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
To evaluate the cytological diagnostic capacity and sample quality of the slow-pull technique and compare them with different suction techniques.
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.
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).
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.
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.