A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy.
Endosc Int Open
; 4(5): E497-505, 2016 May.
Article
en En
| MEDLINE
| ID: mdl-27227104
ABSTRACT
BACKGROUND AND STUDY AIMS:
Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses. PATIENTS ANDMETHODS:
Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy.RESULTS:
A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0â% vs. 67.1â%, Pâ=â0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB 91.7â% vs. FNA 78.4 %, Pâ=â0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2â% vs. 54.5â%, Pâ=â0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (Pâ=â0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5â%, Pâ=â0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities.CONCLUSIONS:
RESULTS of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_financiamento_saude
Tipo de estudio:
Clinical_trials
/
Health_economic_evaluation
Idioma:
En
Revista:
Endosc Int Open
Año:
2016
Tipo del documento:
Article
País de afiliación:
Estados Unidos