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Agreement on endoscopic ultrasonography-guided tissue specimens: Comparing a 20-G fine-needle biopsy to a 25-G fine-needle aspiration needle among academic and non-academic pathologists.

  • Author(s): van Riet, Priscilla A
  • Cahen, Djuna L
  • Biermann, Katharina
  • Hansen, Bettina
  • Larghi, Alberto
  • Rindi, Guido
  • Fellegara, Giovanni
  • Arcidiacono, Paolo
  • Doglioni, Claudio
  • Liberta Decarli, Nicola
  • Iglesias-Garcia, Julio
  • Abdulkader, Ihab
  • Lazare Iglesias, Hector
  • Kitano, Masayuki
  • Chikugo, Takaaki
  • Yasukawa, Satoru
  • van der Valk, Hans
  • Nguyen, Nam Quoc
  • Ruszkiewicz, Andrew
  • Giovannini, Marc
  • Poizat, Flora
  • van der Merwe, Schalk
  • Roskams, Tania
  • Santo, Erwin
  • Marmor, Silvia
  • Chang, Kenneth
  • Lin, Fritz
  • Farrell, James
  • Robert, Marie
  • Bucobo, Juan Carlos
  • Heimann, Alan
  • Baldaque-Silva, Francisco
  • Fernández Moro, Carlos
  • Bruno, Marco J
  • et al.

Published Web Location Commons 'BY' version 4.0 license

Background and aim

A recently carried out randomized controlled trial showed the benefit of a novel 20-G fine-needle biopsy (FNB) over a 25-G fine-needle aspiration (FNA) needle. The current study evaluated the reproducibility of these findings among expert academic and non-academic pathologists.


This study was a side-study of the ASPRO (ASpiration versus PROcore) study. Five centers retrieved 74 (59%) consecutive FNB and 51 (41%) FNA samples from the ASPRO study according to randomization; 64 (51%) pancreatic and 61 (49%) lymph node specimens. Samples were re-reviewed by five expert academic and five non-academic pathologists and rated in terms of sample quality and diagnosis. Ratings were compared between needles, expert academic and non-academic pathologists, target lesions, and cytology versus histological specimens.


Besides a higher diagnostic accuracy, FNB also provided for a better agreement on diagnosing malignancy (ĸ = 0.59 vs ĸ = 0.76, P < 0.001) and classification according to Bethesda (ĸ = 0.45 vs ĸ = 0.61, P < 0.001). This equally applied for expert academic and non-academic pathologists and for pancreatic and lymph node specimens. Sample quality was also rated higher for FNB, but agreement ranged from poor (ĸ = 0.04) to fair (ĸ = 0.55). Histology provided better agreement than cytology, but only when a core specimen was obtained with FNB (P = 0.004 vs P = 0.432).


This study shows that the 20-G FNB outperforms the 25-G FNA needle in terms of diagnostic agreement, independent of the background and experience of the pathologist. This endorses use of the 20-G FNB needle in both expert and lower volume EUS centers.

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