Endoscopic ultrasound-guided trucut biopsy
- Michael J Levy, MD
Michael J Levy, MD
- Professor of Medicine
- Mayo College of Medicine
- Maurits J Wiersema, MD
Maurits J Wiersema, MD
- Clinical Assistant Professor of Medicine
- Indiana University School of Medicine
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 . 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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- Thomas T, Kaye PV, Ragunath K, Aithal G. Efficacy, safety, and predictive factors for a positive yield of EUS-guided Trucut biopsy: a large tertiary referral center experience. Am J Gastroenterol 2009; 104:584.
- DEVICE DESIGN
- DEVICE PREPARATION
- BIOPSY TECHNIQUE
- SPECIMEN HANDLING
- EUS-TCB TECHNICAL DETAILS
- Site of EUS-TCB
- Proper device rotational orientation
- Straightening of the echoendoscope and needle
- EFFICACY AND SAFETY
- Intra- and extra-intestinal mass lesions and lymphadenopathy
- Cystic pancreatic lesions
- Autoimmune pancreatitis
- Chronic pancreatitis
- INDICATIONS AND CONTRAINDICATIONS
- SUMMARY AND RECOMMENDATIONS