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Endoscopic ultrasound-guided trucut biopsy

Michael J Levy, MD
Maurits J Wiersema, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


Endoscopic ultrasound (EUS) is a useful method for evaluating intra- and extra-intestinal mass lesions, and peri-intestinal lymphadenopathy. EUS-guided fine-needle aspiration (FNA) can be performed at the same time as the diagnostic examination and offers a diagnostic accuracy of 60 to 90 percent depending upon the site. (See "Endoscopic ultrasound-guided fine-needle aspiration biopsy in the gastrointestinal tract".)

However, EUS-FNA is associated with several limitations. It may not always be possible to assess the adequacy of sampling during the procedure and cytologic interpretation can be hampered by the presence of blood and benign epithelial cells. Furthermore, tumors that are well differentiated or contain substantial desmoplasia are more difficult to diagnose using cytology alone [1]. Finally, EUS-FNA typically yields a small biopsy sample and destroys the tissue architecture, thereby limiting diagnostic accuracy for lesions such as gastrointestinal stromal tumors and lymphomas [1-3].

Larger caliber cutting needles were designed to overcome many of the problems associated with FNA. These needles acquire larger tissue specimens, thereby preserving tissue architecture and permitting histologic rather than only cytologic examination [4-11]. Several studies have demonstrated that large caliber cutting needles are safe and accurate when used percutaneously, intraluminally, or surgically for diagnosing lesions arising in soft tissue, breast, lung, lymph node, pancreas, liver, kidney, adrenal, spleen, prostate, and other sites [11-23].

Multiple initial attempts were made to adapt a needle system that could be used with the echoendoscope [24,25]. None were successful until the development of the trucut biopsy (TCB) needle (Quick-Core), which could be used with linear echoendoscopes.

Initial studies suggest greater diagnostic accuracy of EUS-TCB compared with EUS-FNA for submucosal mass lesions and lymphoma, and potentially the need for fewer needle passes for diagnosis of solid pancreatic neoplasms. Small studies have also demonstrated the potential to establish a diagnosis in a variety of disorders that would traditionally have required surgery.


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Literature review current through: Sep 2016. | This topic last updated: Jun 15, 2015.
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