Search

Background and Aim Recently, a 22 gauge (G) needle with a Franseen tip design was developed for EUS-guided fine needle biopsy (EUS-FNB). This study evaluated the performance of the Franseen biopsy needle in EUS-guided tissue acquisition. Methods This is a retrospective study of patients who underwent EUS-FNB using the Franseen needle. Lesions were sampled either using only the Franseen needle or after failed diagnostic fine needle aspiration (FNA). After rapid onsite evaluation (ROSE), two dedicated passes were performed for histological assessment using the cell block technique. Main outcomes were (a) rates of diagnostic adequacy for ROSE and histological diagnosis and (b) quality of histology as determined by total tissue area and tumor percentage in tissue. Results 30 patients underwent EUS-FNB of pancreatic or other masses over a 3-month period. 24 lesions were sampled using only the Franseen needle and 6 after failed diagnostic FNA. The final diagnosis was pancreatic cancer in 12, gastrointestinal stromal cell tumor in 5, other tumors in 4 and benign disease in 9. Diagnostic adequacy for ROSE was 96.6% and a histological diagnosis was established in 96.7% of patients. The median tissue area was 2.9mm2 (IQR=0.68-8.71mm2) and the median tumor percentage in tissue was 73.9% (IQR=44-97.6). The rates of technical success and adverse events were 96.7% and 3.3%, respectively. Conclusions Preliminary data suggest that the Franseen needle yields diagnostic material for ROSE and histology in greater than 95% of patients. This article is protected by copyright. All rights reserved.

Endoscopic ultrasound (EUS) is an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. While fine-needle aspiration (FNA) has been routinely carried out for establishing tissue diagnosis, the emerging concept of tailoring chemotherapeutic agents based on molecular markers has increased the demand for core tissue procurement by means of EUS-guided fine-needle biopsy (EUS-FNB). In addition, FNB may offset the limitations of FNA wherein the diagnostic sensitivity is incumbent on the availability of an onsite cytopathologist. Given the increasing number of procedures being done, developing a unit-specific algorithmic approach for needle selection is important to improve the procedural efficiency and utilization of resources. Finally, the best outcomes can be attained only by practicing evidence-based techniques, procuring adequate quantity of sample for ancillary studies and processing the specimens appropriately.