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ORIGINAL ARTICLE
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Comparison of specimen quality among the standard suction, slow-pull, and wet suction techniques for EUS-FNA: A multicenter, prospective, randomized controlled trial


1 Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2 Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
3 Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Fudan University, Shanghai, China
4 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
5 Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
6 Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
7 Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China

Correspondence Address:
Ning Zhong,
Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, 250012, Jinan, Shandong Province
China
Ping-Hong Zhou,
Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai
China
Yi-Qun Zhang,
Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai
China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00163

Background and Objectives: Standard suction technique (SST), slow-pull technique (SPT), and wet suction technique (WEST) of EUS-FNA are designed to improve the diagnostic yields of solid and solid-cystic lesions. We conducted a multicenter, prospective, randomized crossover trial to compare SST, SPT, and WEST on specimen quality and diagnostic accuracy using a 22G needle. Methods: Patients with solid or solid-cystic lesions referred for EUS-FNA at four tertiary hospitals from December 2017 to August 2019 were considered eligible. All lesions were sampled using a 22G needle by the three techniques performed consecutively in a randomized order. The primary outcome was quality of the specimen acquired by each technique regarding blood contamination, tissue integrity and cellularity for diagnosis, graded on a predefined scale. The secondary outcomes were the diagnostic yield of EUS-FNA and the incidence of adverse events. ClinicalTrial. gov registration number: NCT03567863. Results: A total of 300 patients (mean age, 60.6 years, 188 men) were enrolled. WEST was superior (mean score 4.02 ± 1.51) over SST (3.67 ± 1.57, P = 0.018), but comparable to SPT (3.83 ± 1.55, P = 0.370) in overall specimen quality evaluation. WEST produced better tissue integrity (1.42 ± 0.74) and higher cellularity (1.32 ± 0.80) than SST and SPT. SPT (1.43 ± 0.69) was superior to SST (1.27 ± 0.72, P = 0.004) and WEST (1.28 ± 0.71, P = 0.006) in avoiding blood contamination. WEST achieved a diagnostic accuracy of 74.7%, higher than SST (64.4%, P = 0.007) and SPT (65.0%, P = 0.012). One bleeding event occurred with a pancreatic lesion. Conclusions: WEST was comparable to SPT and superior to SST in the overall quality of the specimen and achieved highest diagnostic yield.


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