Endoscopic Ultrasound-Guided Fine Needle Aspiration and Tru-Cut Biopsy

Endoscopic ultrasound-guided (EUS) biopsy, including both fine needle aspiration (FNA) biopsy and histological tru-cut needle biopsy, have now matured into highly valuable methods for acquisition of cytologic and histological specimens. However, a great deal of practice is required before these procedures are mastered. A number of important steps have to be fulfilled, including real time monitoring of the needle during the entire procedure to obtain sufficient material for evaluation. The present review describes the technique of EUS-FNA and tru-cut biopsy, based on a literature review and the authors' extensive experience with these methods. The endoscopes and needle systems available on the market are presented in detail. The biopsy procedure is carefully detailed, including tips and tricks of the trade. Finally, the limitations and complications of the procedure are reviewed in brief, stressing the low rate of complications (below 1-2%), most of which are minor and self limiting.