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Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

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.

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Abbreviations

EUS:

Endoscopic ultrasound

FNA:

Fine needle aspiration

S+:

Syringe-on; the suction syringe with its stopcock closed still attached to the needle handle

S−:

Syringe-off; the suction syringe with its stopcock closed disconnected from the needle handle

−:

Minus (negative pressure)

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Acknowledgments

This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number 8UL1TR000055. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author information

Correspondence to Kulwinder S. Dua.

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The authors declare that they have no conflict of interest.

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Aadam, A.A., Oh, Y.S., Shidham, V.B. et al. Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses. Dig Dis Sci 61, 890–899 (2016) doi:10.1007/s10620-015-3860-0

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Keywords

  • Endoscopic ultrasound (EUS)
  • Tissue acquisition
  • Fine needle aspiration (FNA)
  • Pancreas mass
  • Pancreas adenocarcinoma