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1. Agreement on endoscopic ultrasonography-guided tissue specimens: Comparing a 20-G fine-needle biopsy to a 25-G fine-needle aspiration needle among academic and non-academic pathologists

Author

Priscilla A. Riet, Djuna L. Cahen, Katharina Biermann, Bettina Hansen, Alberto Larghi, Guido Rindi, Giovanni Fellegara, Paolo Arcidiacono, Claudio Doglioni, Nicola Liberta Decarli, Julio Iglesias‐Garcia, Ihab Abdulkader, Hector Lazare Iglesias, Masayuki Kitano, Takaaki Chikugo, Satoru Yasukawa, Hans Valk, Nam Quoc Nguyen, Andrew Ruszkiewicz, Marc Giovannini, Flora Poizat, Schalk Merwe, Tania Roskams, Erwin Santo, Silvia Marmor, Kenneth Chang, Fritz Lin, James Farrell, Marie Robert, Juan Carlos Bucobo, Alan Heimann, Francisco Baldaque‐Silva, Carlos Fernández Moro, Marco J. Bruno, Fabia Attili, Harry Aslanian, Adebowale Adeniran, John G. Lee, Mariachiara Petrone, Erwan Bories, Erez Scapa, Jonathan M. Buscaglia, Maoxin Wu, van Riet, Pa, Cahen, Dl, Biermann, K, Hansen, B, Larghi, A, Rindi, G, Fellegara, G, Arcidiacono, P. G., Doglioni, C, Liberta Decarli, N, Iglesias-Garcia, J, Abdulkader, I, Lazare Iglesias, H, Kitano, M, Chikugo, T, Yasukawa, S, van der Valk, H, Nguyen, Nq, Ruszkiewicz, A, Giovannini, M, Poizat, F, van der Merwe, S, Roskams, T, Santo, E, Marmor, S, Chang, K, Lin, F, Farrell, J, Robert, M, Bucobo, Jc, Heimann, A, Baldaque-Silva, F, Fernández Moro, C, Bruno, Mj., Gastroenterology & Hepatology, Urology, and Surgery

Subjects
medicine.medical_specialty, MULTICENTER, Endoscopic ultrasonography, Endosonography, Fine needle biopsy, law.invention, 03 medical and health sciences, 0302 clinical medicine, GASTROENTEROLOGY EUROPEAN-SOCIETY, Randomized controlled trial, PRECISION MEDICINE, law, Biopsy, medicine, Humans, DIAGNOSTIC-ACCURACY, Radiology, Nuclear Medicine and imaging, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Pancreas, ULTRASOUND, METAANALYSIS, Science & Technology, LESIONS, Gastroenterology & Hepatology, medicine.diagnostic_test, business.industry, Gastroenterology, Liver, Biliary tract and Pancreas, Reproducibility of Results, CORE BIOPSY, Pancreatic Neoplasms, Pathologists, Sample quality, Fine-needle aspiration, ROC Curve, FNA, 030220 oncology & carcinogenesis, FNB, 22-GAUGE ASPIRATION, Original Article, Surgery, 030211 gastroenterology & hepatology, pathology, Clinical Competence, Radiology, interobserver agreement, ORIGINAL ARTICLES, business, Life Sciences & Biomedicine
Abstract

BACKGROUND AND AIM: A recently carried out randomized controlled trial showed the benefit of a novel 20-G fine-needle biopsy (FNB) over a 25-G fine-needle aspiration (FNA) needle. The current study evaluated the reproducibility of these findings among expert academic and non-academic pathologists. METHODS: This study was a side-study of the ASPRO (ASpiration versus PROcore) study. Five centers retrieved 74 (59%) consecutive FNB and 51 (41%) FNA samples from the ASPRO study according to randomization; 64 (51%) pancreatic and 61 (49%) lymph node specimens. Samples were re-reviewed by five expert academic and five non-academic pathologists and rated in terms of sample quality and diagnosis. Ratings were compared between needles, expert academic and non-academic pathologists, target lesions, and cytology versus histological specimens. RESULTS: Besides a higher diagnostic accuracy, FNB also provided for a better agreement on diagnosing malignancy (ĸ = 0.59 vs ĸ = 0.76, P

Published
2019

2. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device

Author

Erwan Bories, Andrew Ruszkiewicz, Erez Scapa, Masayuki Kitano, Flora Poizat, Carlos Fernández Moro, Erwin Santo, Takaaki Chikugo, Guido Rindi, Jonathan M. Buscaglia, M C Petrone, Djuna L. Cahen, Marco J. Bruno, Fabia Attili, Harry R. Aslanian, Adebowale J. Adeniran, Priscilla A. van Riet, Maoxin Wu, Francisco Baldaque-Silva, Silvia Marmor, Julio Iglesias-Garcia, Claudio Doglioni, Nam Q. Nguyen, Paolo Giorgio Arcidiacono, Schalk Van der Merwe, Nicole S. Erler, Marie E. Robert, Ihab Abdulkader, Tania Roskams, Juan Carlos Bucobo, Alan Heimann, Katharina Biermann, Marc Giovannini, John G. Lee, Fritz Lin, Alberto Larghi, Jan-Werner Poley, Kenneth J. Chang, James J. Farrell, van Riet, Pa, Larghi, A, Attili, F, Rindi, G, Nguyen, Nq, Ruszkiewicz, A, Kitano, M, Chikugo, T, Aslanian, H, Farrell, J, Robert, M, Adeniran, A, Van Der Merwe, S, Roskams, T, Chang, K, Lin, F, Lee, Jg, Arcidiacono, P. G., Petrone, M, Doglioni, C, Iglesias-Garcia, J, Abdulkader, I, Giovannini, M, Bories, E, Poizat, F, Santo, E, Scapa, E, Marmor, S, Bucobo, Jc, Buscaglia, Jm, Heimann, A, Wu, M, Baldaque-Silva, F, Moro, Cf, Erler, N, Biermann, K, Poley, Jw, Cahen, Dl, Bruno, Mj., Gastroenterology & Hepatology, Epidemiology, and Pathology

Subjects
Image-Guided Biopsy, Male, medicine.medical_specialty, Lymphoma, Gastrointestinal Stromal Tumors, Lymphadenopathy, Adenocarcinoma, Malignancy, Sensitivity and Specificity, Endosonography, Fine needle biopsy, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Pancreatitis, Chronic, Intestinal Neoplasms, Biopsy, Odds Ratio, Clinical endpoint, medicine, Carcinoma, Humans, Radiology, Nuclear Medicine and imaging, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Aged, medicine.diagnostic_test, business.industry, Gastroenterology, Middle Aged, medicine.disease, Pancreatic Neoplasms, Clinical trial, Neuroendocrine Tumors, Fine-needle aspiration, Needles, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Multivariate Analysis, Carcinoma, Squamous Cell, Female, 030211 gastroenterology & hepatology, Biopsy, Large-Core Needle, Radiology, business
Abstract

Several studies have compared EUS-guided FNA with fine-needle biopsy (FNB), but none have proven superiority. We performed a multicenter randomized controlled trial to compare the performance of a commonly used 25-gauge FNA needle with a newly designed 20-gauge FNB needle.Consecutive patients with a solid lesion were randomized in this international multicenter study between a 25-gauge FNA (EchoTip Ultra) or a 20-gauge FNB needle (ProCore). The primary endpoint was diagnostic accuracy for malignancy and the Bethesda classification (non-diagnostic, benign, atypical, malignant). Technical success, safety, and sample quality were also assessed. Multivariable and supplementary analyses were performed to adjust for confounders.A total of 608 patients were allocated to FNA (n = 306) or FNB (n = 302); 312 pancreatic lesions (51%), 147 lymph nodes (24%), and 149 other lesions (25%). Technical success rate was 100% for the 25-gauge FNA and 99% for the 20-gauge FNB needle (P = .043), with no differences in adverse events. The 20-gauge FNB needle outperformed 25-gauge FNA in terms of histologic yield (77% vs 44%, P .001), accuracy for malignancy (87% vs 78%, P = .002) and Bethesda classification (82% vs 72%, P = .002). This was robust when corrected for indication, lesion size, number of passes, and presence of an on-site pathologist (odds ratio, 3.53; 95% confidence interval, 1.55-8.56; P = .004), and did not differ among centers (P = .836).The 20-gauge FNB needle outperformed the 25-gauge FNA needle in terms of histologic yield and diagnostic accuracy. This benefit was irrespective of the indication and was consistent among participating centers, supporting the general applicability of our findings. (Clinical trial registration number: NCT02167074.).

Published
2019

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