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.
This topic review will summarize clinical experience with EUS-TCB. A discussion on EUS-FNA is presented separately. (See "Endoscopic ultrasound-guided fine-needle aspiration biopsy in the gastrointestinal tract".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Wiersema MJ, Vilmann P, Giovannini M, et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997; 112:1087.
- Ribeiro A, Vazquez-Sequeiros E, Wiersema LM, et al. EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma. Gastrointest Endosc 2001; 53:485.
- Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000; 51:184.
- Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986; 2:165.
- Kovalik EC, Schwab SJ, Gunnells JC, et al. No change in complication rate using spring-loaded gun compared to traditional percutaneous renal allograft biopsy techniques. Clin Nephrol 1996; 45:383.
- Brandt KR, Charboneau JW, Stephens DH, et al. CT- and US-guided biopsy of the pancreas. Radiology 1993; 187:99.
- Welch TJ, Sheedy PF 2nd, Johnson CD, et al. CT-guided biopsy: prospective analysis of 1,000 procedures. Radiology 1989; 171:493.
- Harrison BD, Thorpe RS, Kitchener PG, et al. Percutaneous Trucut lung biopsy in the diagnosis of localised pulmonary lesions. Thorax 1984; 39:493.
- Ingram DM, Sheiner HJ, Shilkin KB. Operative biopsy of the pancreas using the Trucut needle. Aust N Z J Surg 1978; 48:203.
- Lavelle MA, O'Toole A. Trucut biopsy of the prostate. Br J Urol 1994; 73:600.
- Ball AB, Fisher C, Pittam M, et al. Diagnosis of soft tissue tumours by Tru-Cut biopsy. Br J Surg 1990; 77:756.
- Zinzani PL, Colecchia A, Festi D, et al. Ultrasound-guided core-needle biopsy is effective in the initial diagnosis of lymphoma patients. Haematologica 1998; 83:989.
- Hatada T, Ishii H, Ichii S, et al. Diagnostic value of ultrasound-guided fine-needle aspiration biopsy, core-needle biopsy, and evaluation of combined use in the diagnosis of breast lesions. J Am Coll Surg 2000; 190:299.
- Radhakrishnan V. Transrectal Tru-cut biopsy of the prostate using a protective sheath. Br J Urol 1994; 73:454.
- Rodríguez LV, Terris MK. Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol 1998; 160:2115.
- Durup Scheel-Hincke J, Mortensen MB, Pless T, Hovendal CP. Laparoscopic four-way ultrasound probe with histologic biopsy facility using a flexible tru-cut needle. Surg Endosc 2000; 14:867.
- Indinnimeo M, Cicchini C, Stazi A, et al. Trans anal full thickness tru-cut needle biopsies in anal canal tumors after conservative treatment. Oncol Rep 1998; 5:325.
- Sada PN, Ramakrishna B, Thomas CP, et al. Transjugular liver biopsy: a comparison of aspiration and trucut techniques. Liver 1997; 17:257.
- Chau TN, Tong SW, Li TM, et al. Transjugular liver biopsy with an automated trucut-type needle: comparative study with percutaneous liver biopsy. Eur J Gastroenterol Hepatol 2002; 14:19.
- Tweedle DE. Peroperative transduodenal biopsy of the pancreas. Gut 1979; 20:992.
- Johnson CD, Stephens DH, Charboneau JW, et al. Cystic pancreatic tumors: CT and sonographic assessment. AJR Am J Roentgenol 1988; 151:1133.
- Nyman RS, Cappelen-Smith J, Brismar J, et al. Yield and complications in ultrasound-guided biopsy of abdominal lesions. Comparison of fine-needle aspiration biopsy and 1.2-mm needle core biopsy using an automated biopsy gun. Acta Radiol 1995; 36:485.
- Böcking A, Klose KC, Kyll HJ, Hauptmann S. Cytologic versus histologic evaluation of needle biopsy of the lung, hilum and mediastinum. Sensitivity, specificity and typing accuracy. Acta Cytol 1995; 39:463.
- Wiersema MJ, Jondal ML, Schwartz DA, et al. Prospective comparison of a 19- versus 22-gauge needle for performing EUS-FNA of pancreas mass lesions: assessment of accuracy and factors influencing safety. Gastrointest Endosc 2002; 55:AB240.
- Caletti GC, Brocchi E, Ferrari A, et al. Guillotine needle biopsy as a supplement to endosonography in the diagnosis of gastric submucosal tumors. Endoscopy 1991; 23:251.
- Fernández-Esparrach G, Sendino O, Solé M, et al. Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy 2010; 42:292.
- Wiersema MJ, Levy MJ, Harewood GC, et al. Initial experience with EUS-guided trucut needle biopsies of perigastric organs. Gastrointest Endosc 2002; 56:275.
- Levy MJ, Jondal ML, Clain J, Wiersema MJ. Preliminary experience with an EUS-guided trucut biopsy needle compared with EUS-guided FNA. Gastrointest Endosc 2003; 57:101.
- Levy MJ, Wiersema MJ, Clain JE, et al. Comparison of endoscopic ultrasound-guided trucut biopsy (EUS-TCB) to endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) (abstract W1228). Gastrointest Endosc 2003; 57:AB244.
- Varadarajulu S, Fraig M, Schmulewitz N, et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 2004; 36:397.
- Larghi A, Verna EC, Stavropoulos SN, et al. EUS-guided trucut needle biopsies in patients with solid pancreatic masses: a prospective study. Gastrointest Endosc 2004; 59:185.
- Ginès A, Wiersema MJ, Clain JE, et al. Prospective study of a Trucut needle for performing EUS-guided biopsy with EUS-guided FNA rescue. Gastrointest Endosc 2005; 62:597.
- Affi A, Vazquez-Sequeiros E, Norton ID, et al. Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance. Gastrointest Endosc 2001; 53:221.
- Levy MJ, Smyrk TC, Reddy RP, et al. Endoscopic ultrasound-guided trucut biopsy of the cyst wall for diagnosing cystic pancreatic tumors. Clin Gastroenterol Hepatol 2005; 3:974.
- DeWitt J, McGreevy K, LeBlanc J, et al. EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc 2005; 62:76.
- Storch I, Jorda M, Thurer R, et al. Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc 2006; 64:505.
- Kien-Fong Vu C, Chang F, Doig L, Meenan J. A prospective control study of the safety and cellular yield of EUS-guided FNA or Trucut biopsy in patients taking aspirin, nonsteroidal anti-inflammatory drugs, or prophylactic low molecular weight heparin. Gastrointest Endosc 2006; 63:808.
- 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
- Mass lesions and lymphadenopathy
- Cystic pancreatic lesions
- Autoimmune pancreatitis
- When to avoid EUS-TCB
- SUMMARY AND RECOMMENDATIONS