Lee Jeffrey H, Stewart John, Ross William A, Anandasabapathy Sharmila, Xiao Lianchun, Staerkel Gregg
Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd Unit 1433, Houston, TX 77030, USA.
Dig Dis Sci. 2009 Oct;54(10):2274-81. doi: 10.1007/s10620-009-0906-1. Epub 2009 Aug 11.
Both 22- and 25-gauge needles are used for endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of lesions, yet limited data exist on whether either offers an advantage over the other in terms of specimen cellularity and quality.
The aim of this study was to compare sample quality for 22- and 25-gauge needles in EUS-guided FNA of pancreatic and peri-pancreatic lesions.
Between October 2005 and June 2006, 12 patients with pancreatic or peripancreatic lesions underwent EUS-guided FNA with both 22- and 25-gauge Wilson-Cook Echotip needles. All procedures were performed with an Olympus linear echoendoscope by the same endoscopist to eliminate operator-dependent variability. Needle order was selected randomly, and two passes were made with each needle, consisting of ten uniform to-and-fro movements on each pass with 10-ml syringe suction. The specimens were immediately stained and independently reviewed by two cytopathologists, who were blinded to the needle used. Cellularity was graded as 0 to 6, with 6 being most cellular.
No statistically significant difference in cellularity was detected between the two needle size groups by cytologist 1 (mean difference, 0.04; 95% confidence interval [CI], -1.22 to 1.30; p = 0.94) or by cytologist 2 (mean difference, 0.2; 95% CI, -1.23 to 1.65; p = 0.76). When the data from both cytologists were combined, no significant difference in cellularity was detected between the two needle sizes (mean difference, 0.125; 95% CI, -1.22 to 1.47; p = 0.84). No significant difference in cellularity was detected between cytologists 1 and 2 (mean difference, 0.17; 95% CI, -0.15 to 0.48; p = 0.27). When the order in which needles were used was compared, no significant difference in cellularity was detected (p = 0.75). Three mechanical failures occurred with 25-gauge needles, but none occurred with 22-gauge needles. The visibility of the needles on EUS did not differ. Cytologic diagnoses were achieved in all cases: seven pancreatic adenocarcinomas, one pancreatic giant cell carcinoma, one pancreatic neuroendocrine tumor, one metastatic non-small cell carcinoma, one metastatic colon carcinoma, and one pancreatitis. There were no procedure-related complications.
Both FNA needles provided accurate diagnoses in all patients. There was no significant difference between the 22- and 25-gauge needle groups in the independent interpretation of two cytopathologists with respect to cellular yield and ability to render a diagnosis.
22号和25号针均用于内镜超声（EUS）引导下病变的细针穿刺抽吸（FNA），但关于两者在标本细胞数量和质量方面是否优于对方的数据有限。
本研究旨在比较22号和25号针在EUS引导下对胰腺及胰腺周围病变进行FNA时的样本质量。
2005年10月至2006年6月期间，12例胰腺或胰腺周围病变患者接受了使用22号和25号Wilson-Cook EchoTip针进行的EUS引导下FNA。所有操作均由同一位内镜医师使用奥林巴斯线性超声内镜进行，以消除操作者相关的变异性。随机选择针的顺序，每根针进行两次穿刺，每次穿刺包括用10 ml注射器抽吸进行十次均匀的来回移动。标本立即染色，并由两位细胞病理学家独立评估，他们对所使用的针不知情。细胞数量分级为0至6级，6级表示细胞数量最多。
细胞病理学家1（平均差异为0.04；95%置信区间[CI]，-1.22至1.30；p = 0.94）或细胞病理学家2（平均差异为0.2；95% CI，-1.23至1.65；p = 0.76）在两个针尺寸组之间均未检测到细胞数量的统计学显著差异。当将两位细胞病理学家的数据合并时，两个针尺寸之间未检测到细胞数量的显著差异（平均差异为0.125；95% CI，-1.22至1.47；p = 0.84）。细胞病理学家1和2之间在细胞数量上未检测到显著差异（平均差异为0.17；95% CI，-0.15至0.48；p = 0.27）。比较使用针的顺序时，未检测到细胞数量的显著差异（p = 0.75）。25号针发生了3次机械故障，而22号针未发生故障。EUS上针的可视性无差异。所有病例均获得了细胞学诊断：7例胰腺腺癌、1例胰腺巨细胞癌、1例胰腺神经内分泌肿瘤、1例转移性非小细胞癌、1例转移性结肠癌和1例胰腺炎。无与操作相关的并发症。
两种FNA针在所有患者中均提供了准确的诊断。在两位细胞病理学家的独立解读中，22号和25号针组在细胞产量和诊断能力方面无显著差异。
