10 results on '"Bucobo JC"'
Search Results
2. Single-Pass vs 2-Pass Endoscopic Ultrasound-Guided Fine-Needle Biopsy Sample Collection for Creation of Pancreatic Adenocarcinoma Organoids.
- Author
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Lacomb JF, Plenker D, Tiriac H, Bucobo JC, D'souza LS, Khokhar AS, Patel H, Channer B, Joseph D, Wu M, Tuveson DA, Li E, and Buscaglia JM
- Subjects
- Humans, Organoids, Adenocarcinoma diagnosis, Endoscopic Ultrasound-Guided Fine Needle Aspiration methods, Pancreatic Neoplasms diagnosis
- Abstract
Pancreatic ductal adenocarcinoma (PDAC) has one of the poorest prognoses of all malignancies, with a 5-year survival rate <8%.
1 , 2 Suspicious lesions are typically diagnosed via endoscopic ultrasound-guided fine-needle aspiration or endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB).3 Fewer needle passes decreases the risk of postprocedure complications, including pancreatitis and hemorrhage, while allowing additional needle passes to be used for adjuvant tissue testing, such as organoid creation and DNA sequencing., (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
- Full Text
- View/download PDF
3. Combined versus single use 20 G fine-needle biopsy and 25 G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions.
- Author
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van Riet PA, Giorgio Arcidiacono P, Petrone M, Quoc Nguyen N, Kitano M, Chang K, Larghi A, Iglesias-Garcia J, Giovannini M, van der Merwe S, Santo E, Baldaque-Silva F, Bucobo JC, Bruno MJ, Aslanian HR, Cahen DL, and Farrell J
- Subjects
- Endosonography, Humans, Needles, Pancreas diagnostic imaging, Specimen Handling, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Pancreatic Neoplasms diagnostic imaging
- Abstract
Background: Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine-needle aspiration (FNA) and fine-needle biopsy (FNB) consecutively. We explored the yield of combined use of 20 G FNB and 25 G FNA needles in patients with a suspicious solid gastrointestinal lesion., Methods: Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches - FNA followed by FNB, and vice versa., Results: 73 patients were included. There were 39 (53 %) pancreatic lesions, 18 (25 %) submucosal masses, and 16 (22 %) lymph nodes. FNA was used first in 24 patients (33 %) and FNB was used first in 49 (67 %). Generally, FNB was performed after FNA to collect tissue for ancillary testing (75 %), whereas FNA was used after FNB to allow for on-site pathological assessment (76 %). Diagnostic accuracy for malignancy of single needle use increased from 78 % to 92 % with dual sampling ( P = 0.002). FNA followed by FNB improved the diagnostic accuracy for malignancy ( P = 0.03), whereas FNB followed by FNA did not ( P = 0.13)., Conclusion: Dual sampling only improved diagnostic accuracy when 25 G FNA was followed by 20 G FNB and not vice versa. As the diagnostic benefit of the 20 G FNB over the 25 G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice., Competing Interests: Dr. van Riet was a consultant for Cook Medical Devices during the UEGW in 2016. Dr. Bruno is a consultant and lectures for Cook Medical and Boston Scientific., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2020
- Full Text
- View/download PDF
4. 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
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van Riet PA, Cahen DL, Biermann K, Hansen B, Larghi A, Rindi G, Fellegara G, Arcidiacono P, 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, and Bruno MJ
- Subjects
- Humans, ROC Curve, Reproducibility of Results, Clinical Competence, Endoscopic Ultrasound-Guided Fine Needle Aspiration methods, Endosonography methods, Pancreas diagnostic imaging, Pancreatic Neoplasms diagnosis, Pathologists standards
- 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 < 0.001) and classification according to Bethesda (ĸ = 0.45 vs ĸ = 0.61, P < 0.001). This equally applied for expert academic and non-academic pathologists and for pancreatic and lymph node specimens. Sample quality was also rated higher for FNB, but agreement ranged from poor (ĸ = 0.04) to fair (ĸ = 0.55). Histology provided better agreement than cytology, but only when a core specimen was obtained with FNB (P = 0.004 vs P = 0.432)., Conclusion: This study shows that the 20-G FNB outperforms the 25-G FNA needle in terms of diagnostic agreement, independent of the background and experience of the pathologist. This endorses use of the 20-G FNB needle in both expert and lower volume EUS centers., (© 2019 The Authors. Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
- Published
- 2019
- Full Text
- View/download PDF
5. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device.
- Author
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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 PG, 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 NS, Biermann K, Poley JW, Cahen DL, and Bruno MJ
- Subjects
- Adenocarcinoma diagnosis, Adenocarcinoma pathology, Aged, Carcinoma diagnosis, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell pathology, Endosonography, Female, Gastrointestinal Stromal Tumors diagnosis, Humans, Image-Guided Biopsy instrumentation, Intestinal Neoplasms diagnosis, Lymphadenopathy diagnosis, Lymphatic Metastasis, Lymphoma diagnosis, Male, Middle Aged, Multivariate Analysis, Needles, Neuroendocrine Tumors diagnosis, Odds Ratio, Pancreatic Neoplasms diagnosis, Pancreatitis, Chronic diagnosis, Pancreatitis, Chronic pathology, Sensitivity and Specificity, Biopsy, Large-Core Needle instrumentation, Carcinoma pathology, Endoscopic Ultrasound-Guided Fine Needle Aspiration instrumentation, Gastrointestinal Stromal Tumors pathology, Intestinal Neoplasms pathology, Lymphadenopathy pathology, Lymphoma pathology, Neuroendocrine Tumors pathology, Pancreatic Neoplasms pathology
- Abstract
Background and Aims: 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., Methods: 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., Results: 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)., Conclusion: 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.)., (Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
6. Organoid Profiling Identifies Common Responders to Chemotherapy in Pancreatic Cancer.
- Author
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Tiriac H, Belleau P, Engle DD, Plenker D, Deschênes A, Somerville TDD, Froeling FEM, Burkhart RA, Denroche RE, Jang GH, Miyabayashi K, Young CM, Patel H, Ma M, LaComb JF, Palmaira RLD, Javed AA, Huynh JC, Johnson M, Arora K, Robine N, Shah M, Sanghvi R, Goetz AB, Lowder CY, Martello L, Driehuis E, LeComte N, Askan G, Iacobuzio-Donahue CA, Clevers H, Wood LD, Hruban RH, Thompson E, Aguirre AJ, Wolpin BM, Sasson A, Kim J, Wu M, Bucobo JC, Allen P, Sejpal DV, Nealon W, Sullivan JD, Winter JM, Gimotty PA, Grem JL, DiMaio DJ, Buscaglia JM, Grandgenett PM, Brody JR, Hollingsworth MA, O'Kane GM, Notta F, Kim E, Crawford JM, Devoe C, Ocean A, Wolfgang CL, Yu KH, Li E, Vakoc CR, Hubert B, Fischer SE, Wilson JM, Moffitt R, Knox J, Krasnitz A, Gallinger S, and Tuveson DA
- Subjects
- Antineoplastic Agents therapeutic use, Drug Resistance, Neoplasm drug effects, Drug Screening Assays, Antitumor, Gene Expression Regulation, Neoplastic drug effects, Humans, Molecular Targeted Therapy, Organoids chemistry, Organoids cytology, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms genetics, Precision Medicine, Prospective Studies, Sequence Analysis, RNA, Standard of Care, Tumor Cells, Cultured, Antineoplastic Agents pharmacology, Gene Expression Profiling methods, Gene Regulatory Networks drug effects, Organoids drug effects, Pancreatic Neoplasms pathology
- Abstract
Pancreatic cancer is the most lethal common solid malignancy. Systemic therapies are often ineffective, and predictive biomarkers to guide treatment are urgently needed. We generated a pancreatic cancer patient-derived organoid (PDO) library that recapitulates the mutational spectrum and transcriptional subtypes of primary pancreatic cancer. New driver oncogenes were nominated and transcriptomic analyses revealed unique clusters. PDOs exhibited heterogeneous responses to standard-of-care chemotherapeutics and investigational agents. In a case study manner, we found that PDO therapeutic profiles paralleled patient outcomes and that PDOs enabled longitudinal assessment of chemosensitivity and evaluation of synchronous metastases. We derived organoid-based gene expression signatures of chemosensitivity that predicted improved responses for many patients to chemotherapy in both the adjuvant and advanced disease settings. Finally, we nominated alternative treatment strategies for chemorefractory PDOs using targeted agent therapeutic profiling. We propose that combined molecular and therapeutic profiling of PDOs may predict clinical response and enable prospective therapeutic selection. Significance: New approaches to prioritize treatment strategies are urgently needed to improve survival and quality of life for patients with pancreatic cancer. Combined genomic, transcriptomic, and therapeutic profiling of PDOs can identify molecular and functional subtypes of pancreatic cancer, predict therapeutic responses, and facilitate precision medicine for patients with pancreatic cancer. Cancer Discov; 8(9); 1112-29. ©2018 AACR. See related commentary by Collisson, p. 1062 This article is highlighted in the In This Issue feature, p. 1047 ., (©2018 American Association for Cancer Research.)
- Published
- 2018
- Full Text
- View/download PDF
7. Successful creation of pancreatic cancer organoids by means of EUS-guided fine-needle biopsy sampling for personalized cancer treatment.
- Author
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Tiriac H, Bucobo JC, Tzimas D, Grewel S, Lacomb JF, Rowehl LM, Nagula S, Wu M, Kim J, Sasson A, Vignesh S, Martello L, Munoz-Sagastibelza M, Somma J, Tuveson DA, Li E, and Buscaglia JM
- Subjects
- Aged, Aged, 80 and over, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Female, Humans, Male, Middle Aged, Precision Medicine, Tissue Culture Techniques, Tumor Cells, Cultured, Carcinoma, Pancreatic Ductal, Organoids, Pancreatic Neoplasms
- Abstract
Background and Aims: Pancreatic cancer organoids are tumor models of individualized human pancreatic ductal adenocarcinoma (PDA), created from surgical specimens and used for personalized treatment strategies. Unfortunately, most patients with PDA are not operative candidates. Creation of human PDA organoids at the time of initial tumor diagnosis is therefore critical. Our aim was to assess the feasibility of creating human PDA organoids by EUS fine-needle biopsy (EUS-FNB) sampling in patients with PDA., Methods: In this prospective clinical trial in patients referred to evaluate a pancreatic mass, EUS-FNA was performed for initial onsite diagnosis. Two additional needle passes were performed with a 22-gauge FNB needle for organoid creation. Primary outcome was successful isolation of organoids within 2 weeks of EUS-FNB sampling (P0, no passages), confirmed by organoid morphology and positive genotyping., Results: Thirty-seven patients with 38 PDA tumors were enrolled. Successful isolation of organoids (P0) was achieved in 33 of 38 tumors (87%). Establishment of PDA organoid lines for ≥5 passages of growth (P5, five passages) was reached in 25 of 38 tumors (66%). In the single patient with successful P5 FNB sampling-derived and P5 surgically derived organoids, there was identical matching of specimens. There were no serious adverse events. Two patients developed bleeding at the EUS-FNB puncture site requiring hemostasis clips., Conclusions: Pancreatic cancer organoids can be successfully and rapidly created by means of EUS-FNB sampling using a 22-gauge needle at the time of initial diagnosis. Successful organoid generation is essential for precision medicine in patients with pancreatic cancer in whom most are not surgically resectable. (Clinical trial registration number: NCT03140592.)., (Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
8. Case report of intestinal non-rotation, heterotaxy, and polysplenia in a patient with pancreatic cancer.
- Author
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Pagkratis S, Kryeziu S, Lin M, Hoque S, Bucobo JC, Buscaglia JM, Georgakis GV, Sasson AR, and Kim J
- Subjects
- Aged, 80 and over, Female, Humans, Pancreas surgery, Pancreatic Neoplasms complications, Heterotaxy Syndrome complications, Intestinal Volvulus complications, Pancreatectomy methods, Pancreatic Neoplasms surgery, Spleen abnormalities
- Abstract
Rationale: Heterotaxy with polysplenia is an extremely rare congenital condition resulting from abnormal arrangement of organs in the abdominal and thoracic cavities during embryologic development. When a malignancy such as pancreatic cancer develops under these conditions, surgical resection becomes particularly complex. This case report demonstrates successful pancreatic cancer resection despite the patient's complicated anatomy., Patient Concerns: An 82-year-old female presented to our institution with complaints of mild right upper quadrant pain radiating to the mid-epigastric region., Diagnoses: Physical examination revealed jaundice with scleral icterus consistent with obstructive jaundice. Radiographic imaging revealed hepatic duct dilation with several anatomic anomalies including small bowel location in the right upper abdomen, cecum, and appendix in the left lower quadrant, reversed superior mesenteric artery and superior mesenteric vein positions, and right-sided duodenal-jejunal flexture as well as an entirely right-sided pancreas, and left lower pelvis with ≥6 separate splenules. These findings resulted in a diagnosis of heterotaxy syndrome with polysplenia., Interventions: Careful preoperative planning and total pancreatectomy was performed without complication., Outcomes: The patient recovered well. Pathologic examination of the pancreatic mass revealed moderately/poorly differentiated invasive pancreatic duct adenocarcinoma. The patient remains alive and well without signs of recurrent disease at the 2-year follow-up., Lessons: Given the wide range of anatomical variants observed in patients with heterotaxy syndrome, a thorough radiologic assessment is necessary before engaging in any surgical procedure. In our case, preoperative identification of the various anatomic anomalies, such as the short and vertically oriented pancreas, the porta hepatis position anterior to the duodenum, the nonrotation of the intestines and the anomalous origin of the right hepatic artery allowed us to perform a safe and uncomplicated total pancreatectomy.
- Published
- 2017
- Full Text
- View/download PDF
9. 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
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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
10. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device
- Author
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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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