1. 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

2. Disclosures
This study was sponsored by Cook Medical

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

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

5. 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)

6. 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.

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

8. 25 G Procore vs 22 G standard needle
endosonographers

9. 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, B

10. 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

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

12. macroscopic quantity

13. Blood contamination
bloody
no blood
small quantity of
blood

14. 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

15. 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)

16. 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

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

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

19. 22 G Standard Needle 25 G Procore Needle
Il s’agit du cas de Madame Soupart (13p1604)

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

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

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

23. 22 G
25 G Procore

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

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

26. Results
No complications encountered

27. 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 (-)

28. 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

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