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Endoscopy. 2019 Jul 22. doi: 10.1055/a-0966-8755. [Epub ahead of print]

Combined versus single use 20 G fine-needle biopsy and 25 G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions.

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Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Gastroenterology and Gastrointestinal Endoscopy, Vita Salute San Raffaele University, Milan, Italy.
Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.
Department of Gastroenterology and Hepatology, Kindai University, Osaka-Sayama, Japan.
Comprehensive Digestive Disease Center, University of California, Irvine, California, United States.
Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Institut Paoli-Calmettes, Marseilles, France.
Department of Hepatology and Biliopancreatic Disease, University Hospital Leuven, Leuven, Belgium.
Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Gastro Center, Karolinska University Hospital, Huddinge, Sweden.
Division of Gastroenterology, Stony Brook University Hospital, New York, New York, United States.
Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, United States.
Contributed equally



 Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine-needle aspiration (FNA) and fine-needle biopsy (FNB) consecutively. We explored the yield of combined use of 20 G FNB and 25 G FNA needles in patients with a suspicious solid gastrointestinal lesion.


 Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches - FNA followed by FNB, and vice versa.


 73 patients were included. There were 39 (53 %) pancreatic lesions, 18 (25 %) submucosal masses, and 16 (22 %) lymph nodes. FNA was used first in 24 patients (33 %) and FNB was used first in 49 (67 %). Generally, FNB was performed after FNA to collect tissue for ancillary testing (75 %), whereas FNA was used after FNB to allow for on-site pathological assessment (76 %). Diagnostic accuracy for malignancy of single needle use increased from 78 % to 92 % with dual sampling (P = 0.002). FNA followed by FNB improved the diagnostic accuracy for malignancy (P = 0.03), whereas FNB followed by FNA did not (P = 0.13).


 Dual sampling only improved diagnostic accuracy when 25 G FNA was followed by 20 G FNB and not vice versa. As the diagnostic benefit of the 20 G FNB over the 25 G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice.


Conflict of interest statement

Dr. van Riet was a consultant for Cook Medical Devices during the UEGW in 2016. Dr. Bruno is a consultant and lectures for Cook Medical and Boston Scientific.

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