Diagnostic yield of malignancy during EUS-guided FNA of solid lesions with and without a stylet: a prospective, single blind, randomized, controlled trial

Background Use of a stylet during EUS-guided FNA (EUS-FNA) is believed to improve the quality and diagnostic yield of specimens. Objective To compare samples obtained by EUS-FNA with (S+) and without (S−) a stylet for diagnostic yield of malignancy and cytological characteristics. Design Randomized,...

Full description

Saved in:
Bibliographic Details
Published in:Gastrointestinal endoscopy 2012-08, Vol.76 (2), p.328-335
Main Authors: Wani, Sachin, MD, Early, Dayna, MD, Kunkel, Julie, MD, Leathersich, Ann, MD, Hovis, Christine E., BS, Hollander, Thomas G., BS, Kohlmeier, Cara, RDMS, Zelenka, Cynthia, RN, Azar, Riad, MD, Edmundowicz, Steven, MD, Collins, Brian, MD, Liu, Jingxia, PhD, Hall, Matthew, PhD, Mullady, Daniel, MD
Format: Article
Language:English
Subjects:
Abdomen
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Digestive system. Abdomen
Endoscopic Ultrasound-Guided Fine Needle Aspiration - instrumentation
Endoscopy
Female
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Investigative techniques, diagnostic techniques (general aspects)
Lymph Nodes - diagnostic imaging
Lymph Nodes - pathology
Male
Mediastinum
Medical sciences
Middle Aged
Outcome Assessment (Health Care)
Pancreas - diagnostic imaging
Pancreas - pathology
Pancreatic Neoplasms - diagnostic imaging
Pancreatic Neoplasms - pathology
Prospective Studies
Single-Blind Method
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Use of a stylet during EUS-guided FNA (EUS-FNA) is believed to improve the quality and diagnostic yield of specimens. Objective To compare samples obtained by EUS-FNA with (S+) and without (S−) a stylet for diagnostic yield of malignancy and cytological characteristics. Design Randomized, controlled trial. Setting Tertiary referral center. Patients Consecutive patients referred for EUS-FNA of solid lesions. Intervention EUS-FNA; the number of passes was determined by lesion site (6 pancreas/others and 4 lymph nodes). Main Outcome Measurements Diagnostic yield of malignancy and degree of cellularity, specimen adequacy, contamination, and amount of blood. Results One hundred patients were prospectively enrolled in this randomized, controlled trial and the sites of EUS-FNA were the pancreas, 58; lymph node, 25; and other, 17. The overall diagnosis was malignancy in 56, benign in 30, suspicious/atypical in 7, and inadequate specimen in 7 lesions. There were 550 passes made (275 with a stylet and 275 without a stylet). Interim analysis demonstrated no difference in the diagnostic yield of malignancy (94 passes with a stylet [34.2%] vs 110 without a stylet [40%], P = .2) and in the proportion of inadequate specimens (57 with a stylet [20.7%] vs 64 without a stylet [23.3%], P = .2). There was no difference with regard to cellularity ( P = .83), contamination ( P = .31), number of cells ( P = .25), and amount of blood ( P = .6). Similar results were noted in a subgroup analysis based on lesion site. Applying the rules of futility, the study was terminated. Limitations Subjectivity in cytopathologists' assessment, endosonographer not blinded. Conclusions There was no difference in the diagnostic yield of malignancy or proportion of inadequate specimens between passes with and without a stylet. These results suggest that the use of a stylet does not confer any advantage during EUS-FNA. (Clinical trial registration number: NCT01316614 .)
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2012.03.1395