Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an increasingly vital technique for diagnosing liver conditions. The effectiveness of this procedure heavily relies on the adequacy of the tissue sample obtained. A recent study rigorously compared the performance of different needle gauges in EUS-LB, specifically focusing on the 19-gauge fine-needle biopsy (FNB) needle versus the 22-gauge FNB Franseen tip needle. This comparison aimed to determine which needle gauge provides superior specimen quality for accurate diagnosis.
This prospective randomized trial involved 42 patients undergoing EUS-LB. Participants were randomly assigned to undergo biopsy with either a 19-gauge or a 22-gauge FNB needle. In cases where the 22-gauge needle specimen was deemed macroscopically inadequate, an additional pass with a 19-gauge needle was performed to ensure sufficient tissue collection. Bilobar EUS-LB sampling was consistently performed using heparinized wet suction, employing a single pass with 3 actuations per lobe for each needle type. The study meticulously collected and analyzed descriptive statistics to evaluate the performance of each needle gauge.
The patient cohort, primarily referred for EUS-LB due to abnormal liver enzymes (95.5%), consisted predominantly of women (57%) with an average age of 51 years. Notably, in 5 instances where the 22-gauge FNB needle was initially used, the specimens were macroscopically insufficient, necessitating a subsequent biopsy with the 19-gauge FNB needle to obtain an adequate sample. The study revealed a significant difference in tissue core length. The mean preprocessing length of the longest tissue core obtained with the 19-gauge FNB needle was 21.5 ± 6.3 mm, substantially greater than the 9.4 ± 5.5 mm achieved with the 22-gauge FNB needle (P < .001). This significant difference persisted postprocessing, with specimens from the 19-gauge needle averaging 17.4 mm in length compared to just 6.8 mm for the 22-gauge needle (P < .001). Importantly, the study reported no adverse events associated with either needle gauge. Furthermore, patient-reported postprocedure pain and discomfort levels were comparable between the two groups, with 14% reporting discomfort in the 19-gauge group versus 10% in the 22-gauge group (P = .99).
The findings of this study definitively demonstrate the superiority of the 19-gauge FNB needle over the 22-gauge FNB needle for EUS-guided liver biopsy procedures. The 19-gauge needle consistently yielded longer tissue cores and a greater aggregate specimen length, crucial factors for accurate histological diagnosis. Furthermore, the study highlighted that the 22-gauge cores experienced considerably more fragmentation during tissue processing, potentially compromising specimen integrity. Crucially, the use of the 19-gauge needle did not correlate with increased postprocedure pain or adverse events. Therefore, based on this robust comparative evidence, the 19-gauge FNB needle emerges as the preferred choice for EUS-LB sampling, offering enhanced specimen adequacy without compromising patient safety or comfort. This research strongly advocates for the adoption of the 19-gauge FNB needle as the standard for EUS-LB to optimize diagnostic yield and patient care.
