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A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
Background and study aims: Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FN...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
© Georg Thieme Verlag KG
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874800/ https://www.ncbi.nlm.nih.gov/pubmed/27227104 http://dx.doi.org/10.1055/s-0042-106958 |
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author | Aadam, A. Aziz Wani, Sachin Amick, Ashley Shah, Janak N. Bhat, Yasser M. Hamerski, Christopher M. Klapman, Jason B. Muthusamy, V. Raman Watson, Rabindra R. Rademaker, Alfred W. Keswani, Rajesh N. Keefer, Laurie Das, Ananya Komanduri, Srinadh |
author_facet | Aadam, A. Aziz Wani, Sachin Amick, Ashley Shah, Janak N. Bhat, Yasser M. Hamerski, Christopher M. Klapman, Jason B. Muthusamy, V. Raman Watson, Rabindra R. Rademaker, Alfred W. Keswani, Rajesh N. Keefer, Laurie Das, Ananya Komanduri, Srinadh |
author_sort | Aadam, A. Aziz |
collection | PubMed |
description | Background and study aims: Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses. Patients and methods: Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy. Results: A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0 % vs. 67.1 %, P = 0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB: 91.7 % vs. FNA: 78.4 %, P = 0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2 % vs. 54.5 %, P = 0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (P = 0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5 %, P = 0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities. Conclusions: Results of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB. |
format | Online Article Text |
id | pubmed-4874800 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | © Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-48748002016-05-25 A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy Aadam, A. Aziz Wani, Sachin Amick, Ashley Shah, Janak N. Bhat, Yasser M. Hamerski, Christopher M. Klapman, Jason B. Muthusamy, V. Raman Watson, Rabindra R. Rademaker, Alfred W. Keswani, Rajesh N. Keefer, Laurie Das, Ananya Komanduri, Srinadh Endosc Int Open Article Background and study aims: Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses. Patients and methods: Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy. Results: A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0 % vs. 67.1 %, P = 0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB: 91.7 % vs. FNA: 78.4 %, P = 0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2 % vs. 54.5 %, P = 0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (P = 0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5 %, P = 0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities. Conclusions: Results of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB. © Georg Thieme Verlag KG 2016-05 /pmc/articles/PMC4874800/ /pubmed/27227104 http://dx.doi.org/10.1055/s-0042-106958 Text en © Thieme Medical Publishers |
spellingShingle | Article Aadam, A. Aziz Wani, Sachin Amick, Ashley Shah, Janak N. Bhat, Yasser M. Hamerski, Christopher M. Klapman, Jason B. Muthusamy, V. Raman Watson, Rabindra R. Rademaker, Alfred W. Keswani, Rajesh N. Keefer, Laurie Das, Ananya Komanduri, Srinadh A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy |
title | A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
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title_full | A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
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title_fullStr | A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
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title_full_unstemmed | A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
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title_short | A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
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title_sort | randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874800/ https://www.ncbi.nlm.nih.gov/pubmed/27227104 http://dx.doi.org/10.1055/s-0042-106958 |
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