Comparative assessment of diagnostic accuracy and puncture duration of two EUS-FNB needles (22G Franseen vs. 20G antegrade core trap) in patients with solid pancreatic lesions.

INTRODUCTION: Endoscopic ultrasound with fine needle biopsy (EUS-FNB) is the clinical standard for histological confirmation of solid pancreatic lesions. Various types of needles are available. Current guidelines cannot provide recommendations on the type of needle to be used. The aim of the study was to compare the diagnostic accuracy and puncture duration of two EUS-FNB needles (22G Franseen vs. 20G antegrade core trap) in solid pancreatic tumors. METHODS: Between 09/2023 and 02/2025, patients with solid pancreatic masses and indication for histological confirmation by EUS-FNB underwent two puncture procedures at a tertiary hospital, one with a 22G FNB needle and one with a 20G FNB needle. The diagnostic accuracy and puncture duration of both needles were compared. RESULTS: Fifty patients were prospectively included. The mean diameter of the solid lesion was 29.43 mm (±8.69). The final diagnosis was pancreatic adenocarcinoma in 47 patients, neuroendocrine tumor in two patients, and pseudotumor in one patient. In 86% of cases (43/50), the diagnosis was made with the 22G needle, and in 66% (33/50) with the 20G needle. This difference was statistically significant (p = 0.019). When both needles were used in combination, the diagnostic accuracy was 90% (45/50). The average puncture time with the 22G needle was 166 seconds (±73) and with the 20G needle 212 seconds (±93). The difference was significant (p=0.007). CONCLUSION: The 22G FNB needle was superior to the 20G needle in terms of both diagnostic accuracy and puncture time. The study contributes to improving the available data for selecting the most suitable EUS needle types.