Elsevier

Gastrointestinal Endoscopy

Volume 70, Issue 6, December 2009, Pages 1220-1224
Gastrointestinal Endoscopy

New method
Clinical endoscopy
Preliminary experience with a new cytology brush in EUS-guided FNA

https://doi.org/10.1016/j.gie.2009.05.038Get rights and content

Background

Despite the high diagnostic yield of EUS-guided FNA, room for technical improvements remains. Recently, the EchoBrush (Cook Endoscopy, Winston-Salem, NC), a disposable cytologic brush, was introduced to the market. To date, only 1 study, limited to 10 pancreatic cyst cases, using this device has been published.

Objective

To assess the diagnostic yield of the EchoBrush in a cohort of consecutive patients, irrespective of the target lesion.

Design

Case series.

Setting

Tertiary care university hospital (Molinette Hospital, Turin, Italy).

Patients

Thirty-nine consecutive patients (12 with solid pancreatic masses, 12 with pancreatic cysts, 7 with enlarged lymph nodes, and 8 with submucosal masses) were enrolled.

Interventions

The material collected with the EchoBrush and with a standard FNA needle was double-blind evaluated by 2 cytopathologists.

Main Outcome Measurements

Adequacy of the sample and sensitivity and specificity of the EchoBrush method.

Results

Adequate material for cytologic analysis was collected in 17 of 39 patients (43.6%) with a single pass of the EchoBrush. Results were better for pancreatic lesions (for solid and cystic lesions, the adequacy was 58.3% and 50%, respectively); adequacy was low (28.6% and 25%, respectively) for lymph nodes and submucosal masses. The overall sensitivity and specificity were 57.9% and 31.2%, respectively. There were no adverse events with the procedure.

Limitation

Preliminary study.

Conclusions

This report suggests that the EchoBrush may provide adequate cellularity to diagnose solid and cystic pancreatic lesions. More extensive studies are needed to compare the EchoBrush and standard needles.

Section snippets

Patients and methods

Thirty-nine consecutive patients (23 males; mean age 62.5 ± 11.7 years) with different conditions (Table 1) were included in this study, which took place from August to December 2007. Data were retrieved from an institutional review board–approved, prospective, periodically updated, database. All patients signed an informed consent document. Patients with abnormal coagulation parameters (international normalized ratio ≥1.3 and platelet count <75,000/mm3), morbidities contraindicating EUS-FNA,

Results

With the EchoBrush, a single pass was performed irrespective of the kind of lesion; with standard needles, a single pass was performed for cysts, and a mean of 4.3 ± 2.03 (median 4, range 2-9) passes was performed for solid masses. The use of the EchoBrush was precluded in only 1 patient (included in the intention-to-treat analysis) because the target, a small cyst of 2 × 1.7 cm, located in the pancreatic isthmus, could not be properly reached by using the 19-gauge needle but was easily

Discussion

Our study indicates that the EchoBrush is an easy-to-handle and safe device. Even for solid and hard lesions such as stromal tumors, it is easily inserted into the needle and moved to and fro within the mass without complications. In particular, the risk of bleeding was not increased in our series, in contrast to the bleeding in 20% of the patients reported by Al-Haddad et al.9 This discrepancy is probably due to the exclusion, in our study, of patients taking anticoagulants or that only a

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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