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Kaul_EUS FNA FNB_Which Needle Should I Use

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This document discusses the current state of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB) techniques. The author provides an overview of the indications and applications for EUS tissue acquisition in various organs, such as the mediastinum, pancreas, biliary tree, and lymph nodes.<br /><br />The document compares the advantages of using different types of needles for EUS-FNA and EUS-FNB, including reverse bevel, Franseen, and fork-tip needles. It highlights that EUS-FNB provides higher overall tissue volume and allows for pattern recognition, subtyping/classification, and special stains. However, it notes that EUS-FNA using smaller gauge needles is adequate for malignancy (adenocarcinoma).<br /><br />The author discusses the techniques for performing EUS-FNA and EUS-FNB, including the fanning technique and door knock technique, as well as the use of suction during the procedure. It emphasizes the importance of obtaining an adequate sample and provides tips for slide preparation.<br /><br />The document also compares the use of EUS-FNA with rapid on-site evaluation (ROSE) to EUS-FNB alone in terms of diagnostic accuracy and procedure time. It reports that EUS-FNB alone is not inferior to EUS-FNA with ROSE and requires fewer needle passes.<br /><br />The author highlights the advantages of EUS-FNB over EUS-FNA for solid pancreatic lesions, including greater total tissue volume, retained tissue architecture, and adequate samples for immunohistochemistry testing. It also mentions the benefits of EUS-FNB for subepithelial lesions and lymphadenopathy.<br /><br />The document discusses the different types of needles for EUS-FNB and their performance in obtaining samples from solid pancreatic lesions and liver biopsies. It recommends the use of Franseen needles for solid pancreatic lesions and provides tips for performing EUS-guided liver biopsy.<br /><br />The author suggests a strategy for determining the needle type and size based on the suspected diagnosis, lesion location, need for tissue architecture, and the size of the lesion.<br /><br />Finally, the document mentions the complications associated with EUS-FNA, including post-procedure pain, bleeding, infection, perforation, pancreatitis, bile leak, and rare cases of death.<br /><br />Overall, the document provides a comprehensive overview of the current state of EUS-FNA and EUS-FNB techniques, including their indications, techniques, needle selection, and potential complications. It highlights the advantages of EUS-FNB over EUS-FNA in certain scenarios and provides practical tips for performing these procedures effectively.

Keywords

EUS-FNA

EUS-FNB

tissue acquisition

needle selection

pancreatic lesions

lymphadenopathy

needle type

needle size

complications

diagnostic accuracy