ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (Virtual) | February 2023-Kaul_EUS FNA FNB

Kaul_EUS FNA FNB_Which Needle Should I Use

Pdf Summary

This document discusses the current state of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), as well as which needle to use for different indications. The author reviews the various needles available for EUS-FNA and EUS-FNB, including their sensitivities for different types of tissue acquisition. <br /><br />The discussion highlights the advantages of EUS-FNB over EUS-FNA in terms of higher tissue volume, preserved tissue architecture, pattern recognition, subtyping/classification, and special stains. The document also provides techniques for both EUS-FNA and EUS-FNB, emphasizing the fanning technique for FNA and the slow pull technique for FNB. It discusses the importance of needle size and provides insights into wet suction, slow pull, and no suction techniques. Additionally, tips for slide preparation and the use of rapid on-site evaluation (ROSE) are provided.<br /><br />Comparisons are made between EUS-FNA with ROSE and EUS-FNB for solid pancreatic lesions, subepithelial lesions, and lymphadenopathy. The advantages of specific needle designs, such as fork-tip and Franseen needles, for solid pancreatic lesions and liver biopsies are discussed. The document also provides guidelines for choosing the appropriate needle based on the suspected diagnosis, location of the lesion, need for tissue architecture, and index effort versus salvage procedure.<br /><br />The document concludes by highlighting the comparable diagnostic accuracy between EUS-FNA and EUS-FNB, the higher yield of core tissue and preserved architecture with FNB, and the importance of technique and slide preparation. It also notes that complications of EUS-FNA and EUS-FNB are generally acceptable.

Keywords

endoscopic ultrasound-guided fine needle aspiration

EUS-FNA

fine needle biopsy

EUS-FNB

needles

tissue acquisition

EUS-FNB advantages

tissue volume

tissue architecture

pattern recognition