Faculty Collaboration Database

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses. Dig Dis Sci 2016 Mar;61(3):890-9

Date

09/09/2015

Pubmed ID

26346997

Pubmed Central ID

PMC4976479

DOI

10.1007/s10620-015-3860-0

Scopus ID

2-s2.0-84958902170 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

BACKGROUND: Prior to withdrawing the EUS-FNA needle from the lesion, the stopcock of the suction syringe is closed to reduce contamination. Residual negative pressure (RNP) may persist in the needle despite closing the stopcock.

AIMS: To determine whether neutralizing RNP before withdrawing the needle will improve the cytology yield.

METHODS: Bench-top testing was done to confirm the presence of RNP followed by a prospective, randomized, cross-over study on patients with pancreas mass. Ten milliliters of suction was applied to the FNA needle. Before withdrawing the needle from the lesion, the stopcock was closed. Based on randomization, the first pass was done with the stopcock either attached to the needle (S+) or disconnected (S-) to allow air to enter and neutralize RNP and accordingly the second pass was crossed over to S+ or S-. On-site cytopathologist was blinded to S+/S-.

RESULTS: Bench tests confirmed the presence of RNP which was successfully neutralized by disconnecting the syringe (S-) from the needle. Sixty patients were enrolled, 120 samples analyzed. S+ samples showed significantly greater GI tract contamination compared to S- samples (16.7 vs. 6.7%, p = 0.03). Of the 53 patients confirmed to have pancreas adenocarcinoma, FNA using S- approach was positive in 49 (93%) compared to 40 using the S+ approach (76%, p = 0.02).

CONCLUSIONS: Despite closing the stopcock of the suction syringe, RNP is present in the FNA needle. Neutralizing RNP prior to withdrawing the needle from the target lesion significantly decreased GI tract contamination of the sample thereby improving the FNA cytology yield.

CLINICAL TRIALS REGISTRATION NUMBER: NCT01995474.

Author List

Aadam AA, Oh YS, Shidham VB, Khan A, Hunt B, Rao N, Zhang Y, Tarima S, Dua KS

Authors

Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin
Bryan C. Hunt MD Associate Professor in the Pathology department at Medical College of Wisconsin
Sergey S. Tarima PhD Associate Professor in the Data Science Institute department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Aged
Cross-Over Studies
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Humans
Male
Middle Aged
Neuroendocrine Tumors
Pancreatic Neoplasms
Pressure
Suction
Syringes