At individual passes, the needle was positioned at four different areas within the mass and then moved back and forth four times in each area to procure tissue (4 × 4). The needle was positioned at different areas within the mass by using the “up-down” dial of the echoendoscope and with minimal use of the elevator to avoid needle dysfunction. Aspiration was initiated at the left margin and then “fanned” (Video 2 ) until the right margin of the mass was sampled (Fig.2 ).
Following each pass, the procured material was placed onto slides for immediate interpretation by an on-site cytopathologist who was blinded to the procedural technique. Three maximum passes were performed with the initial technique until either the procured specimen was deemed to be of satisfactory diagnostic quality or technical failure occurred. Technical failure was defined as malfunction of the needle apparatus prior to establishing a diagnosis with the original sampling technique. If a definitive diagnosis was established within three passes, the procedure was terminated and the number of passes performed was documented. If no diagnosis was established after three passes (defined as diagnostic failure) or if technical failure occurred, the patient was crossed over and up to three further passes were performed using the alternative sampling method. If diagnostic or technical failure occurred again with the alternative technique, the procedure was aborted and a repeat EUS–FNA was arranged for a different day. The occurrence of any immediate complication was noted at the time of the procedure and late complications were documented with follow-up telephone calls 72 hours post-procedure.
Following each pass, the procured material was placed onto slides for immediate interpretation by an on-site cytopathologist who was blinded to the procedural technique. Three maximum passes were performed with the initial technique until either the procured specimen was deemed to be of satisfactory diagnostic quality or technical failure occurred. Technical failure was defined as malfunction of the needle apparatus prior to establishing a diagnosis with the original sampling technique. If a definitive diagnosis was established within three passes, the procedure was terminated and the number of passes performed was documented. If no diagnosis was established after three passes (defined as diagnostic failure) or if technical failure occurred, the patient was crossed over and up to three further passes were performed using the alternative sampling method. If diagnostic or technical failure occurred again with the alternative technique, the procedure was aborted and a repeat EUS–FNA was arranged for a different day. The occurrence of any immediate complication was noted at the time of the procedure and late complications were documented with follow-up telephone calls 72 hours post-procedure.
