BACKGROUND: Most endosonographers use an EUS needle with an internal stylet during EUS-guided FNA (EUS-FNA). Reinserting the stylet into the needle after every pass is tedious and time-consuming, and there are no data to suggest that it improves the quality of the cytology specimen. OBJECTIVE: To compare the samples obtained by EUS-FNA with and without a stylet for (1) the degree of cellularity, adequacy, contamination, and amount of blood and (2) the diagnostic yield of malignancy. DESIGN: Prospective,single-blind, randomized, controlled trial. SETTING:Two tertiary care referral centers. PATIENTS: Patients referred for EUS-FNA of solid lesions. INTERVENTION: Patients underwent EUS-FNA of the solid lesions, and 2 passes each were made with a stylet and without a stylet in the needle. The order of the passes was randomized, and the cytopathologists reviewing the slides were blinded to the stylet status of passes. MAIN OUTCOME MEASUREMENTS: Degree of cellularity, adequacy, contamination, amount of blood, and the diagnostic yield of malignancy in the specimens. RESULTS: A total of 101 patients with 118 lesions were included in final analysis; 236 FNA passes were made, each with and without a stylet. No significant differences were seen in the cellularity (P = .98), adequacy of the specimen (P = .26), contamination (P = .92), or significant amount of blood (P = .61) between specimens obtained with and without a stylet. The diagnostic yield of malignancy was 55 of 236 specimens (23%) in the with-stylet group compared with 66 of 236 specimens (28%) in the without-stylet group (P = .29). LIMITATIONS: Endosonographers were not blinded to the stylet status of the passes. CONCLUSIONS: Using a stylet during EUS-FNA does not confer any significant advantage with regard to the quality of the specimen obtained or the diagnostic yield of malignancy. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT 01213290).
RCT Entities:
BACKGROUND: Most endosonographers use an EUS needle with an internal stylet during EUS-guided FNA (EUS-FNA). Reinserting the stylet into the needle after every pass is tedious and time-consuming, and there are no data to suggest that it improves the quality of the cytology specimen. OBJECTIVE: To compare the samples obtained by EUS-FNA with and without a stylet for (1) the degree of cellularity, adequacy, contamination, and amount of blood and (2) the diagnostic yield of malignancy. DESIGN: Prospective,single-blind, randomized, controlled trial. SETTING: Two tertiary care referral centers. PATIENTS: Patients referred for EUS-FNA of solid lesions. INTERVENTION: Patients underwent EUS-FNA of the solid lesions, and 2 passes each were made with a stylet and without a stylet in the needle. The order of the passes was randomized, and the cytopathologists reviewing the slides were blinded to the stylet status of passes. MAIN OUTCOME MEASUREMENTS: Degree of cellularity, adequacy, contamination, amount of blood, and the diagnostic yield of malignancy in the specimens. RESULTS: A total of 101 patients with 118 lesions were included in final analysis; 236 FNA passes were made, each with and without a stylet. No significant differences were seen in the cellularity (P = .98), adequacy of the specimen (P = .26), contamination (P = .92), or significant amount of blood (P = .61) between specimens obtained with and without a stylet. The diagnostic yield of malignancy was 55 of 236 specimens (23%) in the with-stylet group compared with 66 of 236 specimens (28%) in the without-stylet group (P = .29). LIMITATIONS: Endosonographers were not blinded to the stylet status of the passes. CONCLUSIONS: Using a stylet during EUS-FNA does not confer any significant advantage with regard to the quality of the specimen obtained or the diagnostic yield of malignancy. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT 01213290).
Authors: Sachin Wani; Michael B Wallace; Jonathan Cohen; Irving M Pike; Douglas G Adler; Michael L Kochman; John G Lieb; Walter G Park; Maged K Rizk; Mandeep S Sawhney; Nicholas J Shaheen; Jeffrey L Tokar Journal: Am J Gastroenterol Date: 2014-12-02 Impact factor: 10.864
Authors: Christopher J DiMaio; Jonathan M Buscaglia; Seth A Gross; Harry R Aslanian; Adam J Goodman; Sammy Ho; Michelle K Kim; Shireen Pais; Felice Schnoll-Sussman; Amrita Sethi; Uzma D Siddiqui; David H Robbins; Douglas G Adler; Satish Nagula Journal: World J Gastrointest Endosc Date: 2014-10-16
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