Observational Study
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World J Gastrointest Endosc. Oct 16, 2014; 6(10): 499-505
Published online Oct 16, 2014. doi: 10.4253/wjge.v6.i10.499
Practice patterns in FNA technique: A survey analysis
Christopher J DiMaio, Jonathan M Buscaglia, Seth A Gross, Harry R Aslanian, Adam J Goodman, Sammy Ho, Michelle K Kim, Shireen Pais, Felice Schnoll-Sussman, Amrita Sethi, Uzma D Siddiqui, David H Robbins, Douglas G Adler, Satish Nagula
Christopher J DiMaio, Michelle K Kim, Henry D Janowitz, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY 10029, United States
Jonathan M Buscaglia, Satish Nagula, Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, NY 11794, United States
Seth A Gross, Adam J Goodman, Division of Gastroenterology, NYU School of Medicine, New York, NY 10016, United States
Harry R Aslanian, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, CT 06510, United States
Sammy Ho, Division of Digestive and Liver Diseases, Montefiore Medical Center, Bronx, New York, NY 10467, United States
Shireen Pais, Division of Gastroenterology and Hepatobiliary Diseases, New York Medical College, Valhalla, New York, NY 10595, United States
Felice Schnoll-Sussman, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10065, United States
Amrita Sethi, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY 10032, United States
Uzma D Siddiqui, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, Illinois, IL 60637, United States
David H Robbins, Division of Gastroenterology, Lenox Hill Hospital, New York, NY 10075, United States
Douglas G Adler, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, UT 84132, United States
Author contributions: All authors contributed to the conception and design of the study, as well as acquisition of data; DiMaio CJ, Buscaglia JM and Nagula S performed the analysis and interpretation of the data; DiMaio CJ drafted the article; all authors contributed to the critical revision of the manuscript and gave final approval to the manuscript.
Correspondence to: Dr. Christopher J DiMaio, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY 10029, United States. christopher.dimaio@mssm.edu
Telephone: +1-212-2417535 Fax: +1-212-2412276
Received: June 15, 2014
Revised: July 31, 2014
Accepted: September 4, 2014
Published online: October 16, 2014
Processing time: 125 Days and 8.5 Hours
Abstract

AIM: To ascertain fine needle aspiration (FNA) techniques by endosonographers with varying levels of experience and environments.

METHODS: A survey study was performed on United States based endosonographers. The subjects completed an anonymous online electronic survey. The main outcome measurements were differences in needle choice, FNA technique, and clinical decision making among endosonographers and how this relates to years in practice, volume of EUS-FNA procedures, and practice environment.

RESULTS: A total of 210 (30.8%) endosonographers completed the survey. Just over half (51.4%) identified themselves as academic/university-based practitioners. The vast majority of respondents (77.1%) identified themselves as high-volume endoscopic ultrasound (EUS) (> 150 EUS/year) and high-volume FNA (> 75 FNA/year) performers (73.3). If final cytology is non-diagnostic, high-volume EUS physicians were more likely than low volume physicians to repeat FNA with a core needle (60.5% vs 31.2%; P = 0.0004), and low volume physicians were more likely to refer patients for either surgical or percutaneous biopsy, (33.4% vs 4.9%, P < 0.0001). Academic physicians were more likely to repeat FNA with a core needle (66.7%) compared to community physicians (40.2%, P < 0.001).

CONCLUSION: There is significant variation in EUS-FNA practices among United States endosonographers. Differences appear to be related to EUS volume and practice environment.

Keywords: Endoscopic ultrasound; Diagnostic procedures and techniques; Fine needle biopsy; Fine needle aspiration

Core tip: Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has become a mainstay in the evaluation of various gastrointestinal diseases. However, little is known about the preferred FNA techniques used by practitioners. The aim of this survey study was to evaluate the practice patterns of a heterogeneous group of endosonographers. Subjects were queried in regards to training, experience, case volume, and preferences regarding FNA needle choice and techniques used. The results demonstrate a moderate variation in EUS-FNA practices among those endosonographers who responded to the survey (n = 210). Significant differences appear to be related to EUS volume and practice environment.