Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy

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 (TEs) (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 VI's) 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 TEs, 26 VI's). 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 0.4-1.6 mm] for TFs vs 1.3 mm 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 VEs. There was no significant difference in the mean number of fiducials placed, indicating a similar degree of technical difficulty for TF and VF deployment. (Gastrointest Endosc 2012; 76:962-71.)