ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (On-Demand) | February 2023-EUS FNA and FNB: Current State of the Art and Which Needle Should I Use?

Video Transcription

Video Summary

The video discusses the concepts, indications, and applications of EUS-guided fine needle aspiration (FNA) and fine needle biopsy (FNB), as well as the devices and techniques used in these procedures. The video highlights that EUS is capable of finding disease pathology and targeting tissue in almost every area of the body except for the small bowel. It discusses the different designs of EUS FNA and FNB needles, and their advantages and limitations.<br /><br />The video emphasizes that both FNA and FNB have high diagnostic accuracy and yield for solid pancreatic lesions. However, the yield is relatively lower for pancreatic cysts and indeterminate strictures. The sensitivity of EUS FNA for lymphadenopathy with cancer is nearly 100%, but for non-malignant diagnoses or reactive lymph nodes, the yield can be lower. For subepithelial lesions, FNB appears to be superior to FNA.<br /><br />The video also highlights the importance of technique in obtaining diagnostic tissue samples. It discusses different techniques for FNA, such as the fanning technique and the door knock technique, and provides tips for targeting smaller lesions. It mentions that FNA typically involves three to five passes, while FNB involves fewer passes.<br /><br />The video discusses the advantages of FNB, such as larger tissue volume and the ability to preserve tissue architecture. It compares different needle designs and recommends the fork-tip and Francine needle designs as high-yield options. The video also mentions the use of rapid on-site evaluation (ROSE) in FNB procedures and suggests that ROSE may not always be necessary for core biopsies.<br /><br />The video concludes by discussing the strategy for determining needle type and size based on the suspected diagnosis, lesion location, need for tissue architecture, and other factors. It also highlights the importance of technique and the favorable complication profile of EUS-FNA and FNB procedures.

Asset Subtitle

Vivek Kaul, MD, FASGE

Keywords

EUS-guided fine needle aspiration

EUS-guided fine needle biopsy

devices and techniques

diagnostic accuracy

FNA and FNB needles

subepithelial lesions