Mok Shaffer R S, Diehl David L, Johal Amitpal S, Khara Harshit S, Confer Bradley D, Mudireddy Prashant R, Kovach Alicia H, Diehl Mia M, Kirchner H Lester, Chen Zong-Ming E
Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States.
Endosc Int Open. 2019 Jan;7(1):E62-E71. doi: 10.1055/a-0655-7462. Epub 2019 Jan 4.
Endoscopic ultrasound-guided liver biopsy uses a 19-gauge (G) needle for parenchymal liver biopsies. We evaluated tissue yields with a 22G fine-needle biopsy (FNB) versus 19G FNA fine-needle aspirate (FNA) device. Biopsies were obtained from 20 patients using the 19G FNA and 22G FNB randomizing each in a cross-over fashion with a blinded outcome assessor. Tissue adequacy for histologic evaluation was the primary outcome, or the proportion of specimens obtaining pathologic diagnosis (portal structures ≥ 5 or length of the longest piece ≥ 15 mm). Additional secondary outcomes included portal and centrilobular inflammation/fibrosis, length of the longest piece, aggregate specimen length, and small (< 5 mm), medium (5 - 8 mm) and large (> 8 mm) fragments. Results were compared in a per needle basis. Patients with cirrhosis were excluded. Eighty biopsies (40 each 19G FNA and 22G FNB) were obtained. Tissue adequacy was greater for the 19G FNA (88 %) versus 22G FNB (68 %), ( = 0.03). There was no difference in total portal structures for the 19G FNA (7.4) and 22G FNB (6.1), ( = 0.28). There was no difference in pre-processing outcomes. After processing, length of the longest piece was higher for the 19G FNA (9.1 mm) versus 22G FNB (6.6 mm), ( = 0.02). More total post-processing small fragments 29.9 versus 20.7, ( = 0.01) and fewer large fragments 1.0 versus 0.4 for the 22G FNB ( = 0.01) were detected. Tissue adequacy was higher for the 19G FNA versus 22G FNB needle. The 22G FNB needle produced samples more prone to fragmentation during specimen processing.
内镜超声引导下肝活检使用19号（G）针进行肝实质活检。我们评估了22G细针活检（FNB）与19G细针抽吸（FNA）装置的组织取材量。对20例患者进行活检，使用19G FNA和22G FNB，以交叉方式随机分组，由一名不知情的结果评估者进行评估。组织是否足以进行组织学评估是主要结果，即获得病理诊断的标本比例（门静脉结构≥5个或最长片段长度≥15mm）。其他次要结果包括门静脉和小叶中心炎症/纤维化、最长片段长度、总标本长度以及小（<5mm）、中（5 - 8mm）和大（>8mm）碎片。结果按每根针进行比较。排除肝硬化患者。共获取80次活检标本（19G FNA和22G FNB各40次）。19G FNA的组织充足率（88%）高于22G FNB（68%），（P = 0.03）。19G FNA的门静脉结构总数（7.4）与22G FNB（6.1）无差异，（P = 0.28）。预处理结果无差异。处理后，19G FNA的最长片段长度（9.1mm）高于22G FNB（6.6mm），（P = 0.02）；检测到22G FNB的总后处理小碎片更多（29.9对20.7），（P = 0.01），大碎片更少（1.0对0.4），（P = 0.01）。19G FNA针的组织充足率高于22G FNB针。22G FNB针所取样本在标本处理过程中更容易破碎。
