COMPARATIVE DIAGNOSTIC PERFORMANCE OF END-CUTTING FINE-NEEDLE BIOPSY NEEDLES FOR ENDOSCOPIC ULTRASOUND TISSUE SAMPLING OF SOLID PANCREATIC MASSES: A NETWORK META-ANALYSIS

Aims We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of available FNB needles for sampling of solid pancreatic lesions.

Methods A systematic literature review (MEDLINE and Cochrane Database) was conducted for studies evaluating the accuracy of newer FNB needles in adults undergoing EUS-guided sampling of solid pancreatic masses. Primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and adverse event rate.

Results Overall, 16 RCTs (1934 patients) were identified. On network meta-analysis, Franseen needle significantly outperformed reverse bevel needle [risk ratio (RR) 1.21(1.05-1.40) for accuracy and 1.31(1.05-1.22) for adequacy) and fine-needle aspiration (FNA: RR 1.21(1.01-1.25) for accuracy and 1.07(1.02-1.13) for adequacy). Likewise, Fork-tip needle was significantly superior to reverse bevel needle [RR 1.17(1.03-1.33) for accuracy and 1.09(1.02-1.16) for adequacy) and to FNA (RR 1.09(1.01-1.19) for accuracy and 1.03(1.01-1.07) for adequacy]. Other comparisons did not achieve statistical significance. As a consequence, Franseen (SUCRA score 0.89 for accuracy and 0.94 for adequacy) and Fork-tip needle (SUCRA score 0.76 for accuracy and 0.73 for adequacy) ranked as the two highest-performing FNB needles. When considering different needle sizes, 25G Franseen and 25G Fork-tip needle were not superior to 22G reverse bevel needle [RR 1.18(0.96-1.46) and RR 1.04(0.62-1.52)]. None of the tested needles resulted significantly superior to the other FNB devices nor to FNA when rapid on-site cytological evaluation was available.

Conclusions Franseen and Fork-tip needle, particularly with 22G size, showed the highest performance for tissue sampling of pancreatic masses, with low confidence in estimates.

Publication History

Article published online:
14 April 2022