Endoscopic Ultrasound-Guided Fine Needle Aspiration by Using 22- and 25-Gauge Needles Alternatively

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Purpose: The standard EUS-FNA needle used is 22 gauge. The purpose of this study was to compare the adequacy of tissue acquisition and diagnostic yield of 22 and 25 (smaller) gauge needles. Methods: It was a retrospective review of all EUS-FNA procedures performed using 22 and 25 gauge needles alternatively in the same patient, over last 15 months period (between 12/01/2006 to 02/29/2008) at a community hospital. Results: Out of total 132 EUS cases, only 16 met the inclusion criteria. Mean age 65.1 years; Gender: 8 males, and 8 females. Out of 16 lesions, 5 were luminal (gastric 4, duodenum 1); and 11 extra-luminal (pancreatic 8, biliary 1, left adrenal 1, and celiac 1). Average size of lesions (mm) was: length 29.5 (range 13.2–40.3) and width 28.8 (range 9.2–53.2). Average number of needle passes was 3.75 (range 2–6). The cytotechnician was present in 12 (75%) cases. The needle pass was considered difficult by the endoscopist in 6 vs. 4 cases with 22 and 25 gauge needles respectively (P-value 0.7). The tissue yield was successful in 16 vs. 15 patients with 22 and 25 gauge needles respectively (P-value 1.0). The specimen adequacy rates were: cytologic 11 vs. 9 (P-value 0.7), and histologic 14 vs. 12 (P-value 0.6); with 22 and 25 gauge needles respectively. Two patients lost follow-up. Out of remaining 14 patients, definitive diagnosis was obtained in 12 and 7 patients with 22 and 25 gauge needles respectively (P-value 0.1). When 22 and 25 gauge needles were combined, the cytologic and histologic adequacy as well as definitive diagnosis was higher but not statistically significant (Table). There was no procedure-related complication.Table: Comparison of 25 and 22 Gauge Needles with Combined Technique.Conclusion: We did not find any statistically significant difference despite relatively easier pass with 25 gauge needle and higher specimen adequacy and definitive diagnosis with 22 gauge needle. Although we found 22 and 25 gauge needles to complement each other when used alternatively in the same patient, the differences did not reach statistical significance due to the small number of cases. We recommend large prospective trials.

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