Surgical Endoscopy

, Volume 32, Issue 9, pp 3777–3782 | Cite as

A prospective randomized trial of EUS-guided tissue acquisition using a 25-gauge core biopsy needle with and without a stylet

  • Min Jae Yang
  • Jae Chul HwangEmail author
  • Byung Moo Yoo
  • Jin Hong Kim
  • Dakeun Lee
  • Hyunee Lim
  • Young Bae Kim



Endoscopic ultrasound (EUS)-guided tissue acquisition has become the most effective method of obtaining specimens from a solid lesion adjacent to the gastrointestinal tract. No data exist regarding the use of a stylet in the core biopsy needle during EUS-guided tissue acquisition. The aims of this study were to evaluate the feasibility, safety, and diagnostic yield of a 25-gauge core biopsy needle without (S−) a stylet and to compare its performance with that of a 25-gauge core biopsy needle with (S+) a stylet in patients with solid lesions adjacent to the gastrointestinal tract.


From November 2013 to January 2016, we performed 114 EUS-guided tissue acquisitions for the diagnosis of solid lesions adjacent to the gastrointestinal tract in a randomized controlled trial. Patients were randomly assigned to the S+ group (n = 57) or the S− group (n = 57). EUS-guided tissue acquisition was performed using a 25-gauge core biopsy needle without an on-site cytopathologist.


There were no significant differences in technical success (100 vs. 100%, p = 1.000), the mean number of needle passes (7.0 ± 1.6 vs. 6.8 ± 1.5, p = 0.556), needle malfunction (0 vs. 1.8%, p = 1.000), or complications (1.8 vs. 0%, p = 1.000) between the S+ and S− groups. Both groups exhibited comparable outcomes with respect to cytological diagnostic accuracy (93.0 vs. 91.2%, p = 1.000) and histological diagnostic accuracy (86.0 vs. 87.7%, p = 1.000) for malignancy. The procedure time was significantly shorter in the S− group than in the S+ group (32.4 ± 11.7 vs. 39.7 ± 8.6 min, p < 0.001).


EUS-guided tissue acquisition using a 25-gauge core biopsy needle without a stylet did not decrease the diagnostic yield for malignancy and was associated with a shorter procedure time than that associated with a stylet.


Endoscopic ultrasound-guided fine-needle aspiration Endosonography Fine-needle aspiration Fine-needle biopsy Stylet 



There is no source of financial support for this study.

Compliance with ethical standards


Min Jae Yang, Jae Chul Hwang, Byung Moo Yoo, Jin Hong Kim, Dakeun Lee, Hyunee Lim, and Young Bae Kim have no conflicts of interest or financial ties to disclose.


  1. 1.
    Erickson RA (2004) EUS-guided FNA. Gastrointest Endosc 60:267–279CrossRefPubMedGoogle Scholar
  2. 2.
    Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ (2012) EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 75:319–331CrossRefPubMedGoogle Scholar
  3. 3.
    Chen VK, Eloubeidi MA (2004) Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol 99:628–633CrossRefPubMedGoogle Scholar
  4. 4.
    Vander Noot MR 3rd, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N, Syed S, Chhieng DC (2004) Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 102:157–163CrossRefPubMedGoogle Scholar
  5. 5.
    Wani S, Early D, Kunkel J, Leathersich A, Hovis CE, Hollander TG, Kohlmeier C, Zelenka C, Azar R, Edmundowicz S, Collins B, Liu J, Hall M, Mullady D (2012) Diagnostic yield of malignancy during EUS-guided FNA of solid lesions with and without a stylet: a prospective, single blind, randomized, controlled trial. Gastrointest Endosc 76:328–335CrossRefPubMedGoogle Scholar
  6. 6.
    Savides TJ (2009) Tricks for improving EUS-FNA accuracy and maximizing cellular yield. Gastrointest Endosc 69:S130-133Google Scholar
  7. 7.
    Hasan MK, Hawes RH (2012) EUS-guided FNA of solid pancreas tumors. Gastrointest Endosc Clin North Am 22:155–167CrossRefGoogle Scholar
  8. 8.
    Ramesh J, Varadarajulu S (2012) How can we get the best results with endoscopic ultrasound-guided fine needle aspiration? Clin Endosc 45:132–137CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Klapman JB, Logrono R, Dye CE, Waxman I (2003) Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration. Am J Gastroenterol 98:1289–1294CrossRefPubMedGoogle Scholar
  10. 10.
    LeBlanc JK, Ciaccia D, Al-Assi MT, McGrath K, Imperiale T, Tao LC, Vallery S, DeWitt J, Sherman S, Collins E (2004) Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc 59:475–481CrossRefPubMedGoogle Scholar
  11. 11.
    Lee JK, Choi JH, Lee KH, Kim KM, Shin JU, Lee JK, Lee KT, Jang KT (2013) A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses. Gastrointest Endosc 77:745–751CrossRefPubMedGoogle Scholar
  12. 12.
    Paik WH, Park Y, Park DH, Hong SM, Lee BU, Choi JH, Lee SS, Seo DW, Lee SK, Kim MH (2015) Prospective evaluation of new 22 gauge endoscopic ultrasound core needle using capillary sampling with stylet slow-pull technique for intra-abdominal solid masses. J Clin Gastroenterol 49:199–205CrossRefPubMedGoogle Scholar
  13. 13.
    Mukai S, Itoi T, Ashida R, Tsuchiya T, Ikeuchi N, Kamada K, Tanaka R, Umeda J, Tonozuka R, Fukutake N, Hoshi K, Moriyasu F, Gotoda T, Irisawa A (2016) Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos). Gastrointest Endosc 83:1210–1217CrossRefPubMedGoogle Scholar
  14. 14.
    Wani S (2014) Basic techniques in endoscopic ultrasound-guided fine-needle aspiration: role of a stylet and suction. Endosc Ultrasound 3:17–21CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wani S, Gupta N, Gaddam S, Singh V, Ulusarac O, Romanas M, Bansal A, Sharma P, Olyaee MS, Rastogi A (2011) A comparative study of endoscopic ultrasound guided fine needle aspiration with and without a stylet. Dig Dis Sci 56:2409–2414CrossRefPubMedGoogle Scholar
  16. 16.
    Rastogi A, Wani S, Gupta N, Singh V, Gaddam S, Reddymasu S, Ulusarac O, Fan F, Romanas M, Dennis KL, Sharma P, Bansal A, Oropeza-Vail M, Olyaee M (2011) A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet. Gastrointest Endosc 74:58–64CrossRefPubMedGoogle Scholar
  17. 17.
    Abe Y, Kawakami H, Oba K, Hayashi T, Yasuda I, Mukai T, Isayama H, Ishiwatari H, Doi S, Nakashima M, Yamamoto N, Kuwatani M, Mitsuhashi T, Hasegawa T, Hirose Y, Yamada T, Tanaka M, Sakamoto N (2015) Effect of a stylet on a histological specimen in EUS-guided fine-needle tissue acquisition by using 22-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 82:837–844CrossRefPubMedGoogle Scholar
  18. 18.
    Sahai AV, Paquin SC, Gariepy G (2010) A prospective comparison of endoscopic ultrasound-guided fine needle aspiration results obtained in the same lesion, with and without the needle stylet. Endoscopy 42:900–903CrossRefPubMedGoogle Scholar
  19. 19.
    Kim JH, Park SW, Kim MK, Lee J, Kae SH, Jang HJ, Koh DH, Choi MH (2016) Meta-analysis for cyto-pathological outcomes in endoscopic ultrasonography-guided fine-needle aspiration with and without the stylet. Dig Dis Sci 61:2175–2184CrossRefPubMedGoogle Scholar
  20. 20.
    Yang MJ, Yim H, Hwang JC, Lee D, Kim YB, Lim SG, Kim SS, Kang JK, Yoo BM, Kim JH (2015) Endoscopic ultrasound-guided sampling of solid pancreatic masses: 22-gauge aspiration versus 25-gauge biopsy needles. BMC Gastroenterol 15:122CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bang JY, Hebert-Magee S, Trevino J, Ramesh J, Varadarajulu S (2012) Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 76:321–327CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyAjou University School of MedicineYeongtong-gu, SuwonRepublic of Korea
  2. 2.Department of PathologyAjou University School of MedicineSuwonRepublic of Korea

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