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A meta-analysis of endoscopic ultrasound–fine-needle aspiration compared to endoscopic ultrasound–fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment
submitted 18 July 2016
accepted after revision 30 December 2016
10 May 2017 (online)
Background The diagnostic yield of endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is variable, and partly dependent upon rapid onsite evaluation (ROSE) by a cytopathologist. Second generation fine-needle biopsy (FNB) needles are being increasingly used to obtain core histological tissue samples.
Aims Studies comparing the diagnostic yield of EUS guided FNA versus FNB have reached conflicting conclusions. We therefore conducted a systematic review and meta-analysis to compare the diagnostic yield of FNA with FNB, and specifically evaluating the diagnostic value of ROSE while comparing the two types of needles.
Methods We searched several databases from inception to 10 April 2016 to identify studies comparing diagnostic yield of second generation FNB needles with standard FNA needles. Risk ratios (RR) were calculated for categorical outcomes of interest (diagnostic adequacy, diagnostic accuracy, and optimal quality histological cores obtained). Standard mean difference (SMD) was calculated for continuous variables (number of passes required for diagnosis). These were pooled using random effects model of meta-analysis to account for heterogeneity. Meta-regression was conducted to evaluate the effect of ROSE on various outcomes of interest.
Results Fifteen studies with a total of 1024 patients were included in the analysis. We found no significant difference in diagnostic adequacy [RR 0.98 (0.91, 1.06), (I 2 = 51 %)]. Although not statistically significant (P = 0.06), by meta-regression, in the absence of ROSE, FNB showed a relatively better diagnostic adequacy. For solid pancreatic lesions only, there was no difference in diagnostic adequacy [RR 0.96 (0.86, 1.09), (I 2 = 66 %)]. By meta-regression, in the absence of ROSE, FNB was associated with better diagnostic adequacy (P = 0.02). There was no difference in diagnostic accuracy [RR 0.99 (0.95, 1.03), (I 2 = 27 %)] or optimal quality core histological sample procurement [RR 0.97 (0.89, 1.05), (I 2 = 9.6 %)]. However, FNB established diagnosis with fewer passes [SMD 0.93 (0.45, 1.42), (I 2 = 84 %)]. The absence of ROSE was associated with a higher SMD, i. e., in the presence of an onsite pathologist, FNA required relatively fewer passes to establish the diagnosis than in the absence of an onsite pathologist.
Conclusions There is no significant difference in the diagnostic yield between FNA and FNB, when FNA is accompanied by ROSE. However, in the absence of ROSE, FNB is associated with a relatively better diagnostic adequacy in solid pancreatic lesions. Also, FNB requires fewer passes to establish the diagnosis.
- 1 Siddiqui UD, Rossi F, Rosenthal LS. et al. EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles. Gastrointest Endosc 2009; 70: 1093-1097
- 2 Vander Noot 3rd MR, Eloubeidi MA, Chen VK. et al. Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 2004; 102: 157-163
- 3 Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine-needle aspiration of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management. Endoscopy 2005; 37: 984-989
- 4 Yasuda I, Tsurumi H, Omar S. et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin. Endoscopy 2006; 38: 919-924
- 5 DeWitt J, Alsatie M, LeBlanc J. et al. Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. Endoscopy 2007; 39: 65-71
- 6 Itoi T, Sofuni A, Itokawa F. et al. Current status of diagnostic endoscopic ultrasonography in the evaluation of pancreatic mass lesions. Dig Endosc 2011; 23 (Suppl. 01) 17-21
- 7 Dumonceau JM, Polkowski M, Larghi A. et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2011; 43: 897-912
- 8 Sepe PS, Moparty B, Pitman MB. et al. EUS-guided FNA for the diagnosis of GI stromal cell tumors: sensitivity and cytologic yield. Gastrointest Endosc 2009; 70: 254-261
- 9 Mizuno N, Bhatia V, Hosoda W. et al. Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA. J Gastroenterol 2009; 44: 742-750
- 10 Ribeiro A, Vazquez-Sequeiros E, Wiersema LM. et al. EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma. Gastrointest Endosc 2001; 53: 485-491
- 11 Na HK, Lee JH, Park YS. et al. Yields and utility of endoscopic ultrasonography-guided 19-gauge Trucut biopsy versus 22-Gauge fine needle aspiration for diagnosing gastric subepithelial tumors. Clin Endosc 2015; 48: 152-157
- 12 Wittmann J, Kocjan G, Sgouros SN. et al. Endoscopic ultrasound-guided tissue sampling by combined fine needle aspiration and trucut needle biopsy: a prospective study. Cytopathology 2006; 17: 27-33
- 13 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
- 14 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
- 15 Taddio A, Pain T, Fassos FF. et al. Quality of nonstructured and structured abstracts of original research articles in the British Medical Journal, the Canadian Medical Association Journal and the Journal of the American Medical Association. CMAJ 1994; 150: 1611-1615
- 16 Scherer RW, Langenberg P, von Elm E. Full publication of results initially presented in abstracts. Cochrane Database Syst Rev 2007; DOI: 10.1002/14651858.MR000005.pub3.
- 17 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
- 18 Deeks JJ, Higgins JPT, Altman DG. on behalf of the Cochrane Statistical Methods Group. Chapter 9: Analysing data and undertaking meta-analyses. In Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.1 [updated September 2008]. Available at: http://handbook.cochrane.org/chapter_9/9_5_2_identifying_and_measuring_heterogeneity.htm [Accessed 10 July 2016]
- 19 Bang JY, Hebert-Magee S, Trevino J. et al. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012; 76: 321-327
- 20 Hucl T, Wee E, Anuradha S. et al. Feasibility and efficiency of a new 22G core needle: a prospective comparison study. Endoscopy 2013; 45: 792-798
- 21 Witt BL, Adler DG, Hilden K. et al. A comparative needle study: EUS-FNA procedures using the HD ProCore(™) and EchoTip(®) 22-gauge needle types. Diagn Cytopathol 2013; 41: 1069-1074
- 22 Kim GH, Cho YK, Kim EY. et al. Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand J Gastroenterol 2014; 49: 347-354
- 23 Vanbiervliet G, Napoleon B, Saint Paul MC. et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46: 1063-1070
- 24 Lee YN, Moon JH, Kim HK. et al. Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study. Endoscopy 2014; 46: 1056-1062
- 25 Strand DS, Jeffus SK, Sauer BG. et al. EUS-guided 22-gauge fine-needle aspiration versus core biopsy needle in the evaluation of solid pancreatic neoplasms. Diagn Cytopathol 2014; 42: 751-758
- 26 Lin M, Hair CD, Green LK. et al. Endoscopic ultrasound-guided fine-needle aspiration with on-site cytopathology versus core biopsy: a comparison of both techniques performed at the same endoscopic session. Endosc Int Open 2014; 2: E220-E223
- 27 Mavrogenis G, Weynand B, Sibille A. et al. 25-gauge histology needle versus 22-gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathy. Endosc Int Open 2015; 3: E63-E68
- 28 Berzosa M, Villa N, El-Serag HB. et al. Comparison of endoscopic ultrasound guided 22-gauge core needle with standard 25-gauge fine-needle aspiration for diagnosing solid pancreatic lesions. Endosc Ultrasound 2015; 4: 28-33
- 29 Alatawi A, Beuvon F, Grabar S. et al. Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United European Gastroenterol J 2015; 3: 343-352
- 30 Yang MJ, Yim H, Hwang JC. et al. Endoscopic ultrasound-guided sampling of solid pancreatic masses: 22-gauge aspiration versus 25-gauge biopsy needles. BMC Gastroenterol 2015; 15: 122
- 31 Dwyer J, Pantanowitz L, Ohori NP. et al. Endoscopic ultrasound-guided FNA and ProCore biopsy in sampling pancreatic and intra-abdominal masses. Cancer Cytopathol 2016; 124: 110-121
- 32 Kandel P, Tranesh G, Nassar A. et al. EUS-guided fine needle biopsy using a novel fork-tip needle: a case-control study. Gastrointest Endosc 2016; 84: 1034-1039
- 33 Rodrigues-Pinto E, Jalaj S, Grimm IS. et al. EUS-guided fine needle biopsy with a new core needle may eliminate the need for an on-site cytopathological assessment. Gastrointest Endosc 2016; 84: 1040-1046
- 34 Varadarajulu S, Fraig M, Schmulewitz N. et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 2004; 36: 397-401
- 35 Storch I, Jorda M, Thurer R. et al. Advantage of EUS Trucut biopsy combined with fine-needle aspiration without immediate on-site cytopathologic examination. Gastrointest Endosc 2006; 64: 505-511
- 36 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48: 339-349
- 37 Schmidt RL, Walker BS, Cohen MB. When is rapid on-site evaluation cost-effective for fine-needle aspiration biopsy?. PLoS One 2015; 10: e0135466