A pilot study of EUS-guided through-the-needle forceps biopsy (with video)

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• 作者：Yousuke Nakai ; MD ; PhD¹ ; ; Hiroyuki Isayama ; MD ; PhD¹ ; Kenneth J. Chang ; MD² ; Natsuyo Yamamoto ; MD ; PhD¹ ; Suguru Mizuno ; MD ; PhD¹ ; Dai Mohri ; MD ; PhD¹ ; Hirofumi Kogure ; MD ; PhD¹ ; Saburo Matsubara ; MD ; PhD¹ ; Minoru Tada ; MD ; PhD¹ ; Kazuhiko Koike ; MD ; PhD¹
• 关键词：EUS-FNA ; EUS-guided FNA ; EUS-TTNFB ; EUS-guided through-the-needle forceps biopsy ; nCLE ; needle-based confocal laser endomicroscopy ; PCN ; pancreatic cystic neoplasm
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：84
• 期：1
• 页码：158-162
• 全文大小：1413 K

文摘

In EUS-guided FNA (EUS-FNA), small-caliber needles are preferable for optimal cytologic yield, whereas large ones are preferable when histologic specimens are needed. Because of the rigidity and friction induced by its large caliber, however, technical limitation does exist in a 19-gauge FNA needle. Recent development of miniature biopsy forceps enables EUS-guided through-the-needle forceps biopsy (EUS-TTNFB). The aim of this study is to evaluate safety and efficacy of EUS-TTNFB.

Methods

Eighteen sessions of EUS-TTNFB in 17 patients with solid lesions were performed by using a 0.75-mm biopsy forceps through a 19-gauge FNA needle. Technical feasibility, safety, and diagnostic yield of EUS-TTNFB were retrospectively studied.

Results

A total of 49 passes, a median of 3 passes per session, were performed, and the needle puncture, advancement and removal of the biopsy forceps, and subsequent EUS-FNA were technically successful in all patients. No adverse events were observed other than one case with hyperamylasemia without pancreatitis. Macroscopic histologic core by EUS-TTNFB was obtained at a rate of 71% per pass. The tissue acquisition rate by EUS-TTNFB alone was 67% per pass and 100% per session. When EUS-TTNFB and subsequent EUS-FNA were combined, the tissue acquisition rate was 94% per pass. The accuracy of combined EUS-TTNFB and EUS-FNA to diagnose malignancy was 88% per pass and 94% per session. With a single pass of EUS-TTNFB and EUS-FNA, the tissue acquisition rate was 89%, and the accuracy to diagnose malignancy was 83%.

Conclusions

EUS-TTNFB was safe and technically feasible and provided additional tissue acquisition with a single puncture of a 19-gauge FNA needle.