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Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the method of choice to obtain samples to reach definitive diagnosis of lesions of the gastrointestinal tract and of adjacent organs, it cannot fully characterize certain neoplasms. The lack of cytology expertise has hindered the dissemination of EUS, limiting its widespread use. The obtainment of a tissue specimen through EUS fine-needle biopsy (EUS-FNB) may overcome the limitations of EUS-FNA. EUS-FNB is expected to move the practice of EUS from cytology to histology, expanding the use of EUS and facilitating targeted therapies and monitoring of treatment response in a more biologically driven manner., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The diagnostic yield of EUS-FNA depends on several factors, such as the experience of the endosonographer, the characteristics of the lesion, the clinical status of the patient, the size and type of needles, the methods of specimen preparation, as well as cytopathologist expertise. The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of FNA are known. Technical challenges of FNA are related to the characteristics of the lesion and its surroundings, sonographic imaging, and limitations related to the needle. Several tips and tricks necessary to overcome them are presented in this review., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Endoscopic ultrasound fine-needle aspiration is considered the technique of choice for acquisition of tissue in and around the digestive tract. The emergence of selective, targeted therapies, directed toward a particular molecular characteristic of an individual patient's tumor is driving the need for biomarker identification and testing in several cancer types. The technique needs improvement to provide more material, in fewer passes, with more flexible, sharp, and clearly echovisible needles, and with a similar safety. Another trend is the avoidance of tissue acquisition, or a more targeted puncture with the help of ancillary techniques, such as optical biopsies with needle-based confocal laser endomicroscopy, contrast-enhanced ultrasonography, and elastography., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This article addresses the technique of endoscopic ultrasound-guided fine-needle aspiration of solid lesions to obtain cytologic specimens. The technique can be broken down into a sequence of steps. The ultimate goal is to maximize the likelihood of obtaining adequate tissue for diagnostic purposes. This requires a technique that ensures that the needle can be moved inside the lesion, under ultrasound guidance, as widely as possible, as easily as possible, and safely. The other variables such as suction, needle type, and stylet use are of secondary importance., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is increasingly used as a diagnostic and therapeutic tool for pancreatic and other gastrointestinal disorders. Several factors affect the outcome of EUS-FNA, one of which is needle size. The decision to use a specific needle depends on factors including location, consistency, and type of the lesion; presence of onsite cytopathologist; and need for additional tissue procurement for histology. This review provides a balanced perspective on the use of different needle sizes available, highlighting the differences among them and potential niche applications of each to maximize diagnostic yield of EUS-FNA., (Copyright © 2014 Elsevier Inc. All rights reserved.)