“Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions

Published:February 28, 2015DOI:


      Contemporary EUS-guided FNA techniques involve the use of a needle, with an air column within the lumen, with or without suction. We describe a novel technique with an aim to improve the quality of the aspirate.


      To compare a novel “wet suction” technique (WEST) with the conventional FNA technique (CFNAT) of EUS-guided FNA using a 22-gauge FNA needle.


      Prospective, single-blind, and randomized trial.


      Two large tertiary-care hospitals.


      All consecutive adult patients presenting for EUS with possible FNA of solid lesions were offered the chance to participate in the study.


      All lesions were sampled with the same needle by using alternating techniques. Patients were randomized to the WEST versus the CFNAT for the first pass. If the first pass was made with the WEST, the second pass was made with the CFNAT, and subsequent passes were made in an alternating manner by using the same sequence. All FNAs were performed using 22-gauge needles.

      Main Outcome Measurements

      Specimen adequacy, cellularity, and blood contamination of EUS-guided FNA aspirates graded on a predefined scale.


      The WEST yielded significantly higher cellularity in a cell block compared with the CFNAT, with a mean cellularity score of 1.82 ± 0.76 versus 1.45 ± 0.768 (P < .0003). The WEST cell block resulted in a significantly better specimen adequacy of 85.5% versus 75.2% (P < .035). There was no difference in the amount of blood contamination between the 2 techniques.


      Lack of cross check and grading by a second cytopathologist.


      The novel WEST resulted in significantly better cellularity and specimen adequacy in cell blocks of EUS-guided FNA aspirate of solid lesions than the CFNAT.


      AMC (Aurora St. Luke's Medical Center), CFNAT (conventional FNA technique), EUS-FNA (EUS-guided FNA), SD (standard deviation), UMN (University of Minnesota Medical Center), WEST (wet suction FNA technique)
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        • Vilmann P.
        • Jacobsen G.K.
        • Henriksen F.W.
        • et al.
        Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease.
        Gastrointest Endosc. 1992; 38: 172-173
        • Shah J.N.
        • Ahmad N.A.
        • Beilstein M.C.
        • et al.
        Clinical impact of endoscopic ultrasonography on the management of malignancies.
        Clin Gastroenterol Hepatol. 2004; 2: 1069-1073
        • Wee E.
        • Lakhtakia S.
        • Gupta R.
        • et al.
        Endoscopic ultrasound guided fine-needle aspiration of lymph nodes and solid masses: factors influencing the cellularity and adequacy of the aspirate.
        J Clin Gastroenterol. 2012; 46: 487-493
        • Dumonceau J.M.
        • Koessler T.
        • Van Hooft J.E.
        • et al.
        Endoscopic ultrasonography-guided fine needle aspiration: relatively low sensitivity in the endosonographer population.
        World J Gastroenterol. 2012; 18: 2357-2363
        • Woolf K.M.
        • Liang H.
        • Sletten Z.J.
        • et al.
        False-negative rate of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid and cystic lesions with matched surgical resections as the gold standard: one institution's experience.
        Cancer Cytopathol. 2013; 121: 449-458
        • Martin H.E.
        • Ellis E.B.
        Biopsy by needle puncture and aspiration.
        Ann Surg. 1930; 92: 169-181
        • Bhutani M.S.
        • Suryaprasad S.
        • Moezzi J.
        • et al.
        Improved technique for performing endoscopic ultrasound guided fine needle aspiration of lymph nodes.
        Endoscopy. 1999; 31: 550-553
        • Puri R.
        • Vilmann P.
        • Saftoiu A.
        • et al.
        Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis.
        Scand J Gastroenterol. 2009; 44: 499-504
        • Lee J.K.
        • Choi J.H.
        • Lee K.H.
        • et al.
        A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses.
        Gastrointest Endosc. 2013; 77: 745-751
        • Larghi A.
        • Noffsinger A.
        • Dye C.E.
        • et al.
        EUS-guided fine needle tissue acquisition by using high negative pressure suction for the evaluation of solid masses: a pilot study.
        Gastrointest Endosc. 2005; 62: 768-774
        • Wallace M.B.
        • Kennedy T.
        • Durkalski V.
        • et al.
        Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy.
        Gastrointest Endosc. 2001; 54: 441-447
        • Nakai Y.
        • Isayama H.
        • Chang K.J.
        • et al.
        Slow pull versus suction in endoscopic ultrasound-guided fine-needle aspiration of pancreatic solid masses.
        Dig Dis Sci. 2014; 59: 1578-1585