ENDOSCOPIC ULTRASOUND FINE-NEEDLE BIOPSY VERSUS FINE-NEEDLE ASPIRATION FOR TISSUE SAMPLING OF LYMPH NODES: A SYSTEMATIC REVIEW AND META-ANALYSIS​​​​​​​​

Aims There is scarce evidence on the comparison between endoscopic ultrasound (EUS) fine-needle biopsy (FNB) and fine-needle aspiration (FNA) of lymph nodes (LNs). Aim of this meta-analysis was to compare the diagnostic performance of these two approaches.

Methods We searched the PubMed/Medline and Embase database through August 2021 and identified 9 studies, of which 4 randomized controlled trials. Primary outcome was diagnostic accuracy. Secondary outcomes were diagnostic sensitivity, specificity, sample adequacy, optimal histological core procurement, number of passes, and adverse events. We performed pairwise meta-analysis through a random effects model and expressed results as odds ratio (OR) or mean difference along with 95% confidence interval (CI).

Results Median age was 67 years and most patients were male in both groups. Diagnostic accuracy was not different between the two approaches (OR 1.31, 95% CI 0.81-2.10; p=0.27). FNB resulted significantly superior to FNA when performed with newer end-cutting needles (OR 1.87, 1.17-3; p=0.009) and in abdominal LNs (OR 2.48, 1.52-4.05; p<0.001). No difference in terms of sample adequacy was observed (OR 1.40, 0.46-4.26; p=0.55) whereas histological core procurement and diagnostic sensitivity were significantly superior with EUS-FNB (OR 6.15, 1.51-25.07 and OR 1.87, 1.27-2.74, respectively). Number of needle passes needed to obtain diagnostic samples was significantly inferior in the FNB group (mean difference -0.54, -0.97 to -0.12; p=0.01). No procedure-related adverse events were observed.

Conclusions Although EUS-FNB could not still be preferred to standard EUS-FNA, newer FNB represent a promising diagnostic tool for LN sampling.

Publication History

Article published online:
14 April 2022