Clin Endosc.  2024 May;57(3):364-374. 10.5946/ce.2023.095.

Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration

• Okuno M
• Iwata K
• Mukai T
• Kito Y
• Tanaka T
• Watanabe N
• Kasahara S
• Iwasa Y
• Sugiyama A
• Nishigaki Y
• Shibata Y
• Kitagawa J
• Iwashita T
• Tomita E
• Shimizu M

• KMID: 2555898
• DOI: http://doi.org/10.5946/ce.2023.095

Abstract

Background/Aims
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML).
Methods
Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles.
Results
Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group.
Conclusions
Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

Keyword

19-gauge; Endoscopic ultrasound-guided fine-needle aspiration; Franseen needle; Lymphadenopathy; Malignant lymphoma

Figure

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  Fig. 1. The process of lymphadenopathy and malignant lymphoma diagnosis using a 19-gauge conventional or Franseen needle. (A) Endoscopic ultrasound (EUS) fine needle aspiration performed under EUS guidance in Doppler mode. (B) Cytology stained with Giemsa shows small, atypical lymphocytes. Scale bar=20 μm. (C) Histopathology shows a lymphoid follicle consisting of small, atypical lymphocytes. Scale bar=50 μm. (D) Immunohistochemical staining is positive in CD20, CD10, Bcl-2, and negative in CD3. (E) The flow cytometry analysis of this case shows the expression of B-cell lineage antigens (CD10, CD19, and CD20) and immunoglobulin light chains (κ). Scale bar=20 μm. (F) A G-banded karyotyping analysis finds t(14;18)(q32;q21) chromosomal translocation (arrows). (G) The fluorescence in situ hybridization assay of this case indicates a green signal for IGH, a red signal for BCL-2, and a yellow signal (arrows) for a fusion of IGH and BCL-2.

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  Fig. 2. Flowchart of patient selection.

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  Fig. 3. A bleeding case in the Franseen needle group. (A) A 20-mm mediastinum lymphadenopathy (arrow) was detected by computed tomography. (B) The lymphadenopathy was punctured via a transesophageal route using a 19-gauge Franseen needle. (C) Mediastinal enlargement with chest pain was observed one day after puncture test. The vessel (arrowheads) was observed in the hematoma around the lymphadenopathy using contrast computed tomography. (D) Embolization of the vessel was required for hemostasis.

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