Prospective randomized comparison of a 22G core needle using standard versus capillary suction for EUS-guided sampling of solid pancreatic masses

BACKGROUND AND STUDY AIMS  The optimal technique for sampling pancreatic lesions with a 22 G Procore needle (pc) is unknown. The aims of this study were to evaluate the 22 Gpc using standard suction technique (SST) and capillary suction technique (CST) and compare diagnostic adequacy of 22 Gpc with the standard 25 G needle. PATIENTS AND METHODS  Sixty consecutive patients referred for EUS-FNA of a solid pancreatic mass were prospectively evaluated. All patients underwent 2 passes with a standard 25 G needle for cytologic analysis. The first group of 30 patients underwent a single pass with the 22 Gpc needle using SST for cytology and histology. The second group underwent a single pass with the 22 Gpc needle using CST. The sequence of passes was randomized. The diagnostic adequacy of each pass was graded by 2 cytopathologists blinded to technique and needle type for comparison. RESULTS  For a cytologic diagnosis with 22 Gpc, an adequate sample was obtained in 82.8 % SST vs. 80.0 % CST ( P  = 0.79). For a histologic diagnosis with 22 Gpc, an adequate sample was obtained in 70.4 % SST vs. 69.0 % CST ( P  = 0.91). A single pass with 22 Gpc provided comparable results to a single pass with the 25 G needle for a cytologic diagnosis; both were superior to a single 22 Gpc pass for a histologic diagnosis. Two passes with the 25 G needle provided a diagnostic specimen in 95.0 % vs 81.4 % with one pass using 22 Gpc ( P  = 0.01). CONCLUSIONS  No significant difference in diagnostic adequacy was observed between techniques for the 22 Gpc. Two passes with a 25 G needle performed better than 1 pass with 22 Gpc. (NCT01598194).