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Background/Aims: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy ofspecimen sampling using endosonography. We conducted this study to evaluate the effcacy of the BLS in sampling of specimens byendoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. Methods: This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on grossvisual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence inthe first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium wasevaluated by a cytopathologist who was blinded to any clinical information. Results: A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) withthe BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement wasobserved both with and without BLS (kappa score 0.40 and 0.29, respectively). Conclusions: The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacyusing gross visual inspection.

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