A Comparative Study of 22G versus 19G Needles for EUS-Guided Biopsies for Parenchymal Liver Disease: Are Thinner Needles Better?

Harsh K. Patel, Romil Saxena, Natalia Rush, Suchi K. Patel, Chandra S. Dasari, Wadad Mneimneh, Ariel Quickery, Mahmoud A. Rahal, Lindsey Temnykh, John DeWitt, Mohammad Al-Haddad

Research output: Contribution to journalArticle

1 Scopus citations


Background and Aims: Data on comparative efficacy of various available endoscopic ultrasound-guided liver biopsy (EUS-LB) needles are limited. We sought to compare the performance of a novel Franseen-tip 22G fine-needle biopsy (FNB) device to that of 19G needle platforms for liver parenchyma. Methods: Consecutive patients referred for EUS and suspected to have hepatic parenchymal disease underwent EUS-LB using different EUS needles and were included in this retrospective study. Two blinded expert liver pathologists independently reviewed and reported on: total number of tissue fragments, length of longest fragment, number of complete and incomplete portal tracts (CPT and IPT), and specimen adequacy. Results: A 22G Franseen-tip needle (A) was used in 30 patients; 19G Tru-Cut needle (B) in 50 patients; 19G reverse beveled non-Tru-Cut needle (C) in 27 patients; and a 19G flexible non-Tru-Cut needle (D) in 28 patients. In the order of needles, A, B, C and D, > 10 tissue fragments were obtained in 100%, 6%, 82%, and 96% samples, the mean number of CPTs was 6.9; 3.0; 7.3; and 16.9, length of longest fragment was 3.8, 4. 7, 3.9, and 8.4 mm, and specimen adequacy was 66.7%, 46%, 82.1%, and 81.5%, respectively. A positive correlation was obtained between number of CPTs and length of longest fragment in samples accrued by 19G needles. Conclusion: EUS-LB specimens using 22G Franseen-tip needle appear highly fragmented, leading to inferior specimen adequacy compared to 19G non-Tru-Cut needles. We also report on using length of longest fragment as an additional criterion for specimen adequacy as it positively correlates with number of CPTs standard.

Original languageEnglish (US)
JournalDigestive diseases and sciences
StateAccepted/In press - Jan 1 2020


  • 22G
  • Adequacy
  • Endoscopic ultrasound
  • Fine-needle aspiration (FNA)
  • Fine-needle biopsy (FNB)
  • Liver biopsy

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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