Endoscopic ultrasound-guided fine-needle aspiration in focal pancreatic lesions: A prospective intraindividual comparison of two needle assemblies

Background and Study Aims: The results of endoscopic ultrasound-guided fine -needle aspiration (EUS-FNA) in focal pancreatic lesions are less impressiv e than those in the mediastinum, The aim of this prospectively randomized s tudy was to compare two commercially available needle assemblies with regar d to handling and cytapathological yield. Patients and Methods: A total of 30 patients (19 men, 11 women; mean age 61 ) with focal pancreatic lesions underwent EUS-FNA with each of the two need les (GIP, Wilson-Cook). The sequence was randomized for the examiner and bl inded for the cytologist. Three patients had to be excluded because of the impossibility of sample assignment or patient follow-up, EUS-FNA was perfor med using the standard technique with linear echo endoscopes. Results: None of the characteristics evaluated by the examiner differed sig nificantly between either of the needles, Inadequate results were obtained in 11% using the GIP needle, but in none with the Wilson-Cook needle. GIP n eedle cytology revealed malignancy in II patients (sensitivity, specificity , and accuracy were 55%, 100%, and 65%, respectively, including inadequate results). The aspirates obtained with the Wilson-Cook needle identified mal ignancy in 16 patients (sensitivity, specificity, and accuracy were 85%, 10 0%, and 89%, respectively). Conclusions: No statistically significant differences were detected in the handling of either of the two needle assemblies. No complications were repo rted using the GTP needles. However, in four procedures breakages of the ou ter Teflon sheath of the Wilson-Cook needle occurred, and in another four c ases re-insertion of the stylet was impossible, Nevertheless, cytopathologi c results were significantly better with the Wilson-Cook needle.