scholarly journals Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis

2020 ◽  
Vol 08 (10) ◽  
pp. E1280-E1290
Author(s):  
Thomas McCarty ◽  
Tarun Rustagi
Keyword(s):  
Systematic Review ◽  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Adverse Event Rate ◽  
Cystic Lesions ◽  
Technical Success ◽  
Common Location

Abstract Background and study aims Given variable diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for pancreatic cystic lesions (PCLs), a through-the-needle (TTN) microforceps biopsy device passed through a 19-gauge FNA needle has been devised to improve tissue sampling. This was a systematic review and meta-analysis to evaluate the feasibility, diagnostic yield, and safety of EUS-guided TTN microforceps biopsy for diagnosis of PCLs. Methods Individualized searches were developed in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, diagnostic yield, accuracy, and procedure-associated adverse events (AEs) as well as comparison to conventional FNA. Results Eleven studies (n = 518 patients; mean age 64.13 ± 5.83 years; 58.19 % female) were included. Mean PCL size was 33.39 ± 3.72 mm with the pancreatic head/uncinate (35.50 %) being the most common location. A mean of 2.47 ± 0.92 forceps passes were performed with a mean of 2.79 ± 0.81 microbiopsies obtained per lesion. Pooled technical success was 97.12 % (95 % CI, 93.73–98.71; I2 = 34.49) with a diagnostic yield of 79.60 % (95 % CI, 72.62–85.16; I2 = 56.00), and accuracy of 82.76 % [(95 % CI, 77.80–86.80; I2 = 0.00). The pooled serious adverse event rate was 1.08 % (95 % CI, 0.43–2.69; I2 = 0.00). Compared to conventional FNA, TTN microforceps biopsy resulted in significant improvement in diagnostic yield [OR 4.79 (95 % CI: 1.52–15.06; P = 0.007)] and diagnostic accuracy [OR 8.69 (95 % CI, 1.12–67.12; P = 0.038)], respectively. Conclusions EUS-guided TTN microforceps biopsy appears to be safe and effective for diagnosis of PCLs with improvement in diagnostic yield and accuracy when compared to FNA alone.

scholarly journals Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review

2020 ◽  
Vol 08 (09) ◽  
pp. E1123-E1133
Author(s):  
Edson Guzmán-Calderón ◽  
Belen Martinez-Moreno ◽  
Juan A. Casellas ◽  
Enrique de Madaria ◽  
José Ramón Aparicio
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Bibliographic Databases ◽  
Technical Failure ◽  
Cystic Lesions ◽  
Technical Success ◽  
Forceps Biopsy ◽  
Tissue Acquisition

Abstract Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs. Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis). Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %). Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.

Su1308 The Use of Suction in Endoscopic Ultrasound With Fine Needle Aspiration: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 83 (5) ◽  
pp. AB346
Author(s):  
Roshanak Rabbanifard ◽  
Seth Lipka ◽  
Andrew Lai ◽  
Benjamin C. Wolk ◽  
Nanxing Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Meta Analysis ◽  
Needle Aspiration ◽  
Fine Needle

scholarly journals Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

2020 ◽  
Vol 08 (05) ◽  
pp. E656-E667 ◽  
Author(s):  
Donevan R. Westerveld ◽  
Sandeep A. Ponniah ◽  
Peter V. Draganov ◽  
Dennis Yang
Keyword(s):  
Systematic Review ◽  
Sensitivity And Specificity ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Concordance Rate ◽  
Surgical Pathology ◽  
Adverse Event Rate ◽  
Secondary Outcome ◽  
Pancreatic Cysts ◽  
Cyst Type

Abstract Background and study aims Accurate diagnosis and risk stratification of pancreatic cysts (PCs) is challenging. The aim of this study was to perform a systematic review and meta-analysis to assess the feasibility, safety, and diagnostic yield of endoscopic ultrasound-guided through-the-needle biopsy (TTNB) versus fine-needle aspiration (FNA) in PCs. Methods Comprehensive search of databases (PubMed, EMBASE, Cochrane, Web of Science) for relevant studies on TTNB of PCs (from inception to June 2019). The primary outcome was to compare the pooled diagnostic yield and concordance rate with surgical pathology of TTNB histology and FNA cytology of PCs. The secondary outcome was to estimate the safety profile of TTNB. Results: Eight studies (426 patients) were included. The diagnostic yield was significantly higher with TTNB over FNA for a specific cyst type (OR: 9.4; 95 % CI: [5.7–15.4]; I2 = 48) or a mucinous cyst (MC) (OR: 3.9; 95 % CI: [2.0–7.4], I2 = 72 %). The concordance rate with surgical pathology was significantly higher with TTNB over FNA for a specific cyst type (OR: 13.5; 95 % CI: [3.5–52.3]; I2 = 48), for a MC (OR: 8.9; 95 % [CI: 1.9–40.8]; I2 = 29), and for MC histologic severity (OR: 10.4; 95 % CI: [2.9–36.9]; I2 = 0). The pooled sensitivity and specificity of TTNB for MCs were 90.1 % (95 % CI: [78.4–97.6]; I2 = 36.5 %) and 94 % (95 % CI: [81.5–99.7]; I2 = 0), respectively. The pooled adverse event rate was 7.0 % (95 % CI: [2.3–14.1]; I2 = 82.9). Conclusions TTNB is safe, has a high sensitivity and specificity for MCs and may be superior to FNA cytology in risk-stratifying MCs and providing a specific cyst diagnosis.

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