Document Detail

Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy.
MedLine Citation:
PMID:  23078921     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: EUS-guided fiducial placement facilitates image-guided radiation therapy (IGRT).
OBJECTIVE: To compare 2 types of commercially available fiducials for technical success, complications, visibility, and migration.
DESIGN: Retrospective, single-center, comparative study.
SETTING: Tertiary-care medical center.
INTERVENTIONS: Traditional fiducials (TFs) (5-mm length, 0.8-mm diameter) and Visicoil fiducials (VFs) (10-mm length, 0.35-mm diameter) were compared. Fiducials were placed using linear 19-gauge (for TFs) or 22-gauge (for VFs) needles. A subjective visualization scoring system (0-2; 0 = not visible, 1 = barely visible, 2 = clearly visible) was used to assess visibility on CT. Fiducial migration was calculated as a change in interfiducial distance.
MAIN OUTCOME MEASUREMENTS: Technical success, complications, visibility, and migration of 2 types of fiducials.
RESULTS: Thirty-nine patients with locally advanced pancreatic cancer underwent EUS-guided placement of 103 fiducials (77 TFs, 26 VFs). The mean number of fiducials placed per patient was 2.66 (standard deviation 0.67) for the 19-gauge needle and 2.60 (standard deviation 0.70) for the 22-gauge needle (P = .83). No intra- or postprocedural complications were encountered. The median visibility score for TFs was significantly better than that for VFs, both when scores of 0 were and were not included (2.00, interquartile range [IQR] 2.00-2.00 vs 1.75, IQR 1.50-2.00, P = .009 and 2.00, IQR 2.00-2.00 vs 2.00, IQR 1.50-2.00, P < .0001, respectively). The mean migration was not significantly different between the 2 types of fiducials (0.8 mm [IQR 0.4-1.6 mm] for TFs vs 1.3 mm [IQR 0.6-1.5 mm] for VFs; P = .72).
LIMITATIONS: Retrospective, nonrandomized design.
CONCLUSIONS: Visibility was significantly better for TFs compared with VFs. The degree of fiducial migration was not significantly different for TFs and VFs. There was no significant difference in the mean number of fiducials placed, indicating a similar degree of technical difficulty for TF and VF deployment.
Mouen A Khashab; Katherine J Kim; Erik J Tryggestad; Aaron T Wild; Teboh Roland; Vikesh K Singh; Anne Marie Lennon; Eun Ji Shin; Mark A Ziegler; Reem Z Sharaiha; Marcia Irene Canto; Joseph M Herman
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  76     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-19     Completed Date:  2013-04-29     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  962-71     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland 21205, USA.
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MeSH Terms
Aged, 80 and over
Chi-Square Distribution
Equipment Design
Fiducial Markers* / adverse effects
Middle Aged
Pancreatic Neoplasms / surgery*,  ultrasonography
Radiosurgery / instrumentation*
Retrospective Studies
Statistics, Nonparametric
Ultrasonography, Interventional
Grant Support
P30 CA006973/CA/NCI NIH HHS; R01 CA 161613/CA/NCI NIH HHS

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