Departments of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Departments of Pathology, National Cheng Kung University Hospital, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Gut Liver. 2023 Mar 15;17(2):318-327. doi: 10.5009/gnl220030. Epub 2022 Sep 2.
BACKGROUND/AIMS: A high-quality sample allows for next-generation sequencing and the administration of more tailored precision medicine treatments. We aimed to evaluate whether heparinized wet suction can obtain higher quality samples than the standard dry-suction method during endoscopic ultrasound (EUS)-guided biopsy of pancreatic masses.
A prospective randomized crossover study was conducted. Patients with a solid pancreatic mass were randomly allocated to receive either heparinized wet suction first or dry suction first. For each method, two needle passes were made, followed by a switch to the other method for a total of four needle punctures. The primary outcome was the aggregated white tissue length. Histological blood contamination, diagnostic performance and adverse events were analyzed as secondary outcomes. In addition, the correlation between white tissue length and the extracted DNA amount was analyzed.
A total of 50 patients were enrolled, and 200 specimens were acquired (100 with heparinized wet suction and 100 with dry suction), with one minor bleeding event. The heparinized wet suction approach yielded specimens with longer aggregated white tissue length (11.07 mm vs 7.96 mm, p=0.001) and less blood contamination (p=0.008). A trend towards decreasing tissue quality was observed for the 2nd pass of the dry-suction method, leading to decreased diagnostic sensitivity and accuracy, although the accumulated diagnostic performance was comparable between the two suction methods. The amount of extracted DNA correlated positively to the white tissue length (p=0.001, Spearman̕s ρ=0.568).
Heparinized wet suction for EUS tissue acquisition of solid pancreatic masses can yield longer, bloodless, DNA-rich tissue without increasing the incidence of adverse events (ClinicalTrials.gov. identifier NCT04707560).
背景/目的：高质量的样本可用于下一代测序，并实施更具针对性的精准医疗治疗。我们旨在评估在超声内镜（EUS）引导下胰腺肿块活检中，肝素化湿抽吸是否比标准干吸法能获得更高质量的样本。
进行了一项前瞻性随机交叉研究。将接受 EUS 引导下胰腺肿块活检的患者随机分为肝素化湿抽吸组或标准干吸组。对于每种方法，进行两次穿刺，然后切换到另一种方法，总共进行 4 次穿刺。主要结局是总白色组织长度。分析了组织学血液污染、诊断性能和不良事件等次要结局。此外，还分析了白色组织长度与提取 DNA 量之间的相关性。
共纳入 50 例患者，共采集 200 个标本（肝素化湿抽吸组 100 个，标准干吸组 100 个），仅发生 1 例轻微出血事件。肝素化湿抽吸组的白色组织长度更长（11.07mm 比 7.96mm，p=0.001），血液污染更少（p=0.008）。标准干吸组第 2 次穿刺的组织质量呈下降趋势，导致诊断敏感性和准确性降低，但两种抽吸方法的累积诊断性能相当。提取的 DNA 量与白色组织长度呈正相关（p=0.001，Spearman̕s ρ=0.568）。
肝素化湿抽吸用于 EUS 采集胰腺实性肿块组织可获得更长、无血、富含 DNA 的组织，且不增加不良事件的发生率（ClinicalTrials.gov.标识符 NCT04707560）。
