Procedure Endoscopic ultrasonography was performed using a linear echo-endoscope by five experienced echo-endoscopist with a current case volume of at list 500 per year (200 FNA). The standard technique for FNA was adopted: the needle is advanced under real-time EUS guidance into the target lesion by using a quick, strong thrust of the handle. The stylet is completely withdrawn and a syringe attached to the end of the needle device. Once inside the lesion, after applying negative pressure suction by opening the lock device of the syringe, the needle is moved back and forth 15 times under EUS guidance. The suction syringe is then released, the needle withdrawn into the catheter, and the whole system removed from the echoendoscope.