A preloaded 22-gauge fine-needle system facilitating placement of a higher number of fiducials for image-guided radiation therapy compared with traditional backloaded 19-gauge approach.

Abstract

BACKGROUND AND AIMS\nImage-guided radiation therapy (IGRT) often relies on EUS-guided fiducial markers. Previously used manually backloaded fiducial needles have multiple potential limitations including safety and efficiency concerns. Our aim was to evaluate the efficacy, feasibility, and safety of EUS-guided placement of gold fiducials using a novel preloaded 22-gauge needle, compared with a traditional, backloaded 19-gauge needle.\n\n\nMETHODS\nThis was a single-center comparative cohort study. Patients with pancreatic and hepatobiliary malignancy who underwent EUS-guided fiducial placement between October 2014 and February 2018 were included. The main outcome was the technical success of fiducial placement. Secondary outcomes were mean procedure time, fiducial visibility during IGRT, technical success of IGRT delivery, and adverse events.\n\n\nRESULTS\nA total of 114 patients underwent EUS-guided fiducial placement during the study period. Of these, 111 patients had successful placement of a minimum of 2 fiducials. 56 patients underwent placement using a backloaded 19-gauge needle and 58 patients underwent placement using a 22-gauge preloaded needle. The mean number of fiducials placed successfully at the target site was significantly higher in the 22-gauge group compared with 19-gauge group (3.53 ± 0.96 vs 3.11 ± 0.61, respectively, p=0.006). In the 22-gauge group, the clinical goal of placing 4 fiducials was achieved in 78%, compared with 23% in the 19-gauge group (p<0.001). In univariate analyses, gender, age, procedure time, tumor size and location did not influence the number of successfully placed fiducials. Technical success of IGRT with fiducial tracking was high in both the 19-gauge (51/56, 91%), and the 22-gauge group (47/58, 81%), p = 0.12.\n\n\nCONCLUSIONS\nEUS-guided placement of fiducials using a preloaded 22-gauge needle is feasible, effective, safe, and allows for a higher number of fiducials placed when compared with the traditional backloaded 19-gauge needle.