Background Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine-needle aspiration (FNA) and fine-needle biopsy (FNB) consecutively. We explored the yield of combined use of 20G FNB and 25G FNA needles in patients with a suspicious solid gastrointestinal lesion. Methods Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches - FNA followed by FNB, and vice versa. Results 73 patients were included. There were 39 (53%) pancreatic lesions, 18 (25%) submucosal masses, and 16 (22%) lymph nodes. FNA was used first in 24 patients (33%) and FNB was used first in 49 (67%). Generally, FNB was performed after FNA to collect tissue for ancillary testing (75%), whereas FNA was used after FNB to allow for on-site pathological assessment (76%). Diagnostic accuracy for malignancy of single needle use increased from 78% to 92% with dual sampling (P =0.002). FNA followed by FNB improved the diagnostic accuracy for malignancy (P =0.03), whereas FNB followed by FNA did not (P =0.13). Conclusion Dual sampling only improved diagnostic accuracy when 25G FNA was followed by 20G FNB and not vice versa. As the diagnostic benefit of the 20G FNB over the 25G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice.

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Journal Endoscopy
van Riet, P.A, Giorgio Arcidiacono, P. (Paolo), Petrone, M.C, Quoc Nguyen, N. (Nam), Kitano, M. (Masayuki), Chang, K. (Kenneth), … Farrell, J. (James). (2020). Combined versus single use 20G fine-needle biopsy and 25G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions. Endoscopy, 52(1), 37–44. doi:10.1055/a-0966-8755