Randomized controlled trial comparing the Franseen needle with the Fork-tip needle for EUS-guided fine-needle biopsy

      Background and Aims

      EUS-guided FNA primarily provides cytologic samples. EUS-guided fine-needle biopsy (FNB) with needles that provide histologic specimens may enhance diagnostic yield and facilitate accessory tissue staining. Several different needle designs are currently available and design superiority is unknown. We designed a randomized controlled trial to compare 2 commonly used EUS-FNB needles in their ability to provide histologic tissue samples (primary endpoint) and to reach an accurate diagnosis (secondary endpoint).


      A total of 150 lesions from 134 patients (November 2018 to June 2019) were randomized 1:1 between biopsy with a Franseen needle and a Fork-tip needle. The groups were compared regarding the quality of the tissue samples and diagnostic accuracy.


      Of 150 lesions, 75 were pancreatic and 75 were other solid lesions in and around the GI tract. There was no statistically significant difference between the Franseen needle and the Fork-tip needle in the yield of adequate histologic samples, 71 of 75 (94.7%) versus 72 of 75 (96%), (P = 1.00), an absolute difference of −1.3% (95% confidence interval [CI], −8.1% to 5.4%). The 2 groups were similar in the diagnostic accuracy of histologic analysis, 64 of 75 (85.3%) versus 68 of 75 (90.7%) (P = .45), absolute difference −5.4% (95% CI, −15.7% to 5%); and in the diagnostic accuracy of combined cytologic and histologic analysis, 65 of 75 (86.7%) versus 69 of 75 (92%) (P = .43), absolute difference −5.3% (95% CI, −15.2% to 4.5%).


      There was no significant difference in the performance of the Franseen needle versus the Fork-tip needle. Both needles achieved a high yield of histologic tissue samples and high diagnostic accuracy. (Clinical trial registration number: NCT03672032.)

      Graphical abstract


      CI (confidence interval), IQR (interquartile range), ROSE (rapid on-site evaluation)
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      Linked Article

      • Franseen versus fork-tip: Crowning the king of crown-cut needles?
        Gastrointestinal EndoscopyVol. 93Issue 1
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          EUS-guided tissue acquisition is a widely accepted and invaluable method for diagnosing masses within and adjacent to the upper GI tract and mediastinum. The first needle developed for this purpose had a simple design with a beveled tip and was mainly used to obtain cytologic material (FNA).1,2 The efficacy of FNA needles was subsequently confirmed in numerous studies that reported sensitivity rates >90% and specificity close to 100%.3-5 However, in subepithelial lesions, these needles perform rather moderately (diagnostic accuracy 67% to 84%).
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