EUS-FNA using a 25-G ProCoreTM histology needle versus a 22-G standard cytology needle in the differential diagnosis of solid lesions and lymphadenopathies Mavrogenis G1,2, Sibille A1, Weynand B3, Hassaini H1, Deprez P2, Gillain C1, Warzée P1   1. Grand Hôpital de Charleroi 2. Cliniques Universitaires de Saint Luc 3. CHU Mont-Godinne

Disclosures This study was sponsored by Cook Medical

How to improve the yield of EUS-FNA? Needle size? Number of passes? Use of stylet? Aspiration On site pathologist Needle design www.youtube.endoscopyvideo

ProCoreTM (beveled) histology needle ‘The Procore needle works like a cheeze grater’

What do we know until now? Procore needles introduced in 2010 22 G Procore: sensitivity: 87.5% (Giovannini, DDW 2011) 25 G Procore first pass sensitivity: 88% (Iwashita, DDW 2012) 19 G Procore, sensitivity: 90% (Inglesias-Garcia, GIE 2011)

Procore or not Procore? Similar results for the cytology parameters, amount of diagnostic cell block material, adequacy, and accuracy However, statistically significant trend toward fewer passes to achieve adequacy with the procore needle: 2.9 vs 2.1 passes.

Procore or not Procore? No significant difference in procurement of the histologic core or the presence of diagnostic histologic specimens

25 G Procore vs 22 G standard needle endosonographers

Materials and Methods EUS FNA of solid lesions and lymph nodes Exclusion criteria: coagulation disorders, pregnancy, no informed consent Dec 2012-Oct 2013 Each Lesion puctured by both needles: Cook Echotip 22 G and Cook Procore 25 G Liquid based cytology (Cytolyt, Thinprep Processor) Blind analysis by one experienced cytologist Final diagnosis based on cytological findings, surgical specimen, clinical, radiological evolution clinicaltrials.gov, B027201316271

EUS FNA sampling: 1 pass, 2nd Needle 3rd pass optional 1 pass, 1st Needle Every lesion was punctured ONCE by BOTH needles in a random order A third puncture was performed if necessary not included at the study

Puncture technique Capillary sampling: 10-15 to-and-fro movements kindly provided by Cook Medical

macroscopic quantity

Blood contamination bloody no blood small quantity of blood

Cytology-Histology score 0 = not sufficient material or contaminated material 1= rare diagnostic cells 2= diagnostic cells at every 10x field 3= diagnostic cells at every 20x field

Results Median age: 69 years (range: 38-88) 33 lesions 29 patients,19 females, 10 males Median age: 69 years (range: 38-88) 33 lesions Median follow up: 7 months (range: 1-12)

Results Final diagnosis Number of cases Liver metastasis 2 Cholangiocarcinoma 1 Gastric submucosal tumor Pancreatic adenocarcinoma Pancreatic neuroendocrine tumor 18 Malignant lymph node 6 Benign lymph node 3 Mediastinal malignancy Total 33

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

22 G Standard Needle 25 G Procore Needle Il s’agit du cas de Madame Soupart (13p1604)

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

22 G 25 G Procore

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

Results ¶=Wilcoxon rank sum test, §=Paired t-test, *=McNemar’s test.

Results No complications encountered

False negative results Malignant Lesion Number of cases 22 G missed cases 25 G Procore Liver metastasis 2 Cholangiocarcinoma 1 Gastric submucosal tumor Pancreatic cancer 19 Lymph nodes 6 Mediastinal malignancy Total missed cases 6/30 5/30 in 1 case both needles were (-) in 2 cases both needles were (-)

False negative results Malignant Lesion Number of cases 22 G missed cases 25 G Procore Liver metastasis 2 Cholangiocarcinoma 1 Gastric submucosal tumor Pancreatic cancer 19 Lymph nodes 6 Mediastinal malignancy Total missed cases 6/30 5/30 89% sensitivity 89% sensitivity 80% sensitivity 83.3% sensitivity

Conclusion Both needles were safe and successful in terms of high diagnostic yield, with similar histo-cytological results.