Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Gastrointestinal and Pancreatic Tumors: Is Negative Pressure Helpful or Does It Suck?

Excerpt

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) facilitates endoscopic tissue acquisition. The technique is affected by two major categories of factors: that influencing sample acquisition and that influencing sample interpretation, some subject to controversy [1]. The former factors include: the degree of technical difficulty (location of the lesion), the type of lesion (solid or cystic), the diameter of the needle (19-, 22-, or 25-gauge), the number of punctures, the use of negative pressure (presence and amount including capillary aspiration, namely slow-pull technique), the presence of stylets, the presence of rapid on-site evaluation (ROSE), the type of needle (a dedicated biopsy needle, with or without a side hole at the needle tip, and with or without a core trap at the needle tip), any special maneuvers (“fanning” technique) used, and the experience and skills of the endosonographer. The factors affecting interpretation are contamination and mimicry of other types of lesions. …