Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2016
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
_version_ 1782433089133215744
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
title_full A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
title_fullStr A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
title_full_unstemmed A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
title_short A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy
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
work_keys_str_mv AT aadamaaziz arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT wanisachin arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT amickashley arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT shahjanakn arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT bhatyasserm arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT hamerskichristopherm arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT klapmanjasonb arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT muthusamyvraman arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT watsonrabindrar arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT rademakeralfredw arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT keswanirajeshn arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT keeferlaurie arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT dasananya arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT komandurisrinadh arandomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT aadamaaziz randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT wanisachin randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT amickashley randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT shahjanakn randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT bhatyasserm randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT hamerskichristopherm randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT klapmanjasonb randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT muthusamyvraman randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT watsonrabindrar randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT rademakeralfredw randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT keswanirajeshn randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT keeferlaurie randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT dasananya randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy
AT komandurisrinadh randomizedcontrolledcrossovertrialandcostanalysiscomparingendoscopicultrasoundfineneedleaspirationandfineneedlebiopsy