Although the several techniques for improved outcomes in EUS-guided tissue acquisition are reported, the reported diagnostic yield for pancreatic solid tumors to date is not satisfactory. Among these technique, fanning method is well known superior to the standard approach in clinical practice. Instead of this, the effects of torque technique by twisting of scope to clock-wise or counter clock-wise direction during EUS-guided tissue acquisition of pancreatic mass lesions is not known. This study compared diagnostic yield obtained from EUS-guided tissue acquisition of pancreatic masses using torque technique and standard technique. 

Treatment

Torque technique
During each needle passage, the needle can be firstly advanced into the counterclockwise margin within the lesion under ultrasound guidance. And then, the endosonographer tried to make repetitive back-and-forth thrusting movements at the same time as twisting the body of the echoendoscope to the right (clockwise) with the lesion without using the left/right control knob. For individual needle passage, 10 uniform back-and-forth movements were performed within the lesion. The number of needle passages had been decided upon as only three times and was maintained constant based on previous noted reportsand our experience.

Standard technique
After puncture, the needle was repeatedly moved back and forth within the lesion 10 times with a thrusting and pulling force to scrape off the histologic tissue. The endosonographer paid more attention to pushing the needle sharply in to shear off tissue and pulling back slowly so that they enter the needle. Once a passage has been completed, deactivate suction and withdraw the needle completely into the sheath. And then, endosonographer repeat all the procedure from needle puncture to withdrawal, 3 times. In subsequent passes, a different margin of the mass was targeted but the needle movement was confined to the same area.

Arm Label

Target Number of Participant

Arm Type

Arm Description

During each needle passage, the needle can be firstly advanced into the counterclockwise margin within the lesion under ultrasound guidance. And then, the endosonographer tried to make repetitive back-and-forth thrusting movements at the same time as twisting the body of the echoendoscope to the right (clockwise) with the lesion without using the left/right control knob. For individual needle passage, 10 uniform back-and-forth movements were performed within the lesion. The number of needle passages had been decided upon as only three times and was maintained constant based on previous noted reports and our experience.

Arm Label

Target Number of Participant

Arm Type

Arm Description

Standard technique
After puncture, the needle was repeatedly moved back and forth within the lesion 10 times with a thrusting and pulling force to scrape off the histologic tissue. The endosonographer paid more attention to pushing the needle sharply in to shear off tissue and pulling back slowly so that they enter the needle. Once a passage has been completed, deactivate suction and withdraw the needle completely into the sheath. And then, endosonographer repeat all the procedure from needle puncture to withdrawal, 3 times. In subsequent passes, a different margin of the mass was targeted but the needle movement was confined to the same area.

Gender

Age

Description

Patients were eligible for the study based on the following criteria: suspected solid pancreatic masses based on clinical work up and image modality that required cytopathological confirmation. 

Exclusion criteria included: 
(a) cystic pancreatic lesions without the evidence of solid component suspected with malignant transformation; 
(b) cardiopulmonary instability; 
(c) severe coagulopathy (international normalized ratio > 1.5 or platelet count < 50,000 cells/cubic millimeter [cmm3]); 
(d) inability to suspend antithrombotic therapy; 
(e) pregnancy;
(f) refusal to provide informed consent or participate in the study. 

the procurement rates of histologic cores that the cyto-pathologist considered to be of optimal quality for histological evaluation of the needle gauge used for the EUS-FNB procedure

1-2 weeks after interventional EUS (after confirmation of final pathologic report)

diagnostic performance: diagnostic accuracy, sensitivity, specificity, PPV, NPV

1-2 weeks after interventional EUS (after confirmation of final pathologic report)

Technical failure

1-2 weeks after interventional EUS (after confirmation of final pathologic report)

Procedure related adverse events

1-2 weeks after interventional EUS (after confirmation of final pathologic report)