scholarly journals 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

2017 ◽  
Vol 05 (05) ◽  
pp. E363-E375 ◽  
Author(s):  
Muhammad Khan ◽  
Ian Grimm ◽  
Bilal Ali ◽  
Richard Nollan ◽  
Claudio Tombazzi ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Significant Difference ◽  
Meta Regression ◽  
Optimal Quality

Abstract 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.

scholarly journals An exclusive fine-needle biopsy approach to sampling solid lesions under EUS guidance: a prospective cohort study

2020 ◽  
Vol 8 (5) ◽  
pp. 349-354
Author(s):  
Lindsey M Temnykh ◽  
Mahmoud A Rahal ◽  
Zahra Zia ◽  
Mohammad A Al-Haddad
Keyword(s):  
Adverse Events ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Procedure Time ◽  
Fine Needle ◽  
Significant Difference ◽  
Solid Lesions ◽  
Procedural Outcomes

Abstract Background Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is increasingly utilized to enhance the cytological yield of sampling solid lesions, but its superiority over existing fine-needle aspiration (FNA) platforms has not been clearly demonstrated. The aim of our study was to compare the diagnostic accuracy and procedural outcomes of FNB using a new Franseen-tip needle to that of a traditional FNA in sampling solid lesions under EUS guidance. Methods Consecutive patients with solid lesions referred for EUS-FNB sampling were included. Procedure-related outcomes were collected prospectively including patient demographics, number of passes performed, diagnostic sample adequacy, adverse events, and recovery time. The Acquire needle was used to sample all lesions in the study group. Consecutive EUS-FNA procedures performed to sample solid lesions using the Expect needle were utilized as controls. Results There were 180 patients undergoing EUS-FNB compared to 183 patients undergoing EUS-FNA procedures for solid-lesion sampling. The procedure time was significantly shorter in patients who underwent FNB compared to FNA (mean: 37.4 vs 44.9 minutes, P < 0.001). Significantly fewer passes were performed in the FNB cohort compared to the FNA group (mean: 2.9 vs 3.8, P < 0.001). The cytologic diagnostic yield was significantly higher in the FNB group compared to the FNA group (98.3% vs 90.2%, P = 0.003). No significant difference in the incidence of adverse events was observed between the FNB and FNA groups (1.1% vs 0.5%, P = 0.564). Conclusions An FNB-exclusive approach to sampling solid lesions under EUS guidance is safe and feasible, and may result in fewer overall passes, shorter procedure time, and improved diagnostic adequacy. FNB may replace FNA as the primary sampling modality of choice in all solid lesions.

scholarly journals Usefulness of a Fork-Tip Needle in Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Gastric Subepithelial Lesions

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1883
Author(s):  
Mika Takasumi ◽  
Takuto Hikichi ◽  
Minami Hashimoto ◽  
Jun Nakamura ◽  
Tsunetaka Kato ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Significant Difference ◽  
Subepithelial Lesions

The sample adequacy and diagnostic accuracy of an endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) for gastric subepithelial lesions (SELs) have been reported to be imperfect. To resolve these issues, a fork-tip needle as an EUS-guided fine-needle biopsy (FNB) needle has been developed. This study was conducted to evaluate the usefulness of a fork-tip needle in an EUS-FNB for gastric SELs. Seventy-nine patients who received an EUS-FNA or FNB using a fork-tip needle for gastric SELs were included in the study. The sample adequacy and diagnostic accuracy were compared between the EUS-FNB with the fork-tip needle group (fork-tip group, n = 13) and the EUS-FNA with FNA needle group (FNA group, n = 66). In addition, a multivariate analysis of the factors influencing diagnostic accuracy was conducted. Regarding sample adequacy, there was no significant difference between the groups (100% vs. 90.9%, respectively; p = 0.582). The diagnostic accuracy of the fork-tip group was numerically higher than that of the FNA group (92.3% vs. 81.8%, respectively; p = 0.682). In a multivariate analysis, the diagnostic accuracy was related to the tumor size and location of the SEL but not to the needle type. In conclusion, this study does not show statistical superiority, but suggests the useful potential of a fork-tip needle.

scholarly journals Use of suction during endoscopic ultrasound-guided fine needle biopsy of solid pancreatic lesions with a Franseen-tip needle: a pilot comparative trial

2021 ◽  
Vol 09 (03) ◽  
pp. E401-E408
Author(s):  
Pedro Costa-Moreira ◽  
Filipe Vilas-Boas ◽  
Diana Martins ◽  
Pedro Moutinho-Ribeiro ◽  
Susana Lopes ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Blood Contamination ◽  
Fine Needle ◽  
Significant Difference ◽  
The Impact

Abstract Background and study aims The utility of suction during endoscopic ultrasound (EUS) fine-needle biopsy (FNB) using Franseen-tip needle remains unclear and has not been evaluated in randomized trials. We designed a randomized crossover trial to compare the diagnostic yield during EUS-FNB using a 22G Franseen-tip needle, with and without standard suction. Patients and methods Consecutive patients undergoing EUS-guided sampling of solid pancreatic lesions were recruited. A minimum of two passes were performed for each case: one with 20-mL syringe suction (S+) and another without (S–). The order of passes was randomized and the pathologist blinded. The endpoints were the diagnostic yield and the impact of blood contamination in the diagnosis. Results Fifty consecutive patients were enrolled. The overall diagnostic accuracy was 84 %. A diagnosis of malignancy was obtained in 70 samples: 36 in the S+group and 34 in the S–group. A statistically significant difference was seen in the diagnostic accuracy (S+: 78 % vs. S–: 72 %, P < 0.01) and blood contamination (S+: 68 %; S–: 44 %, P < 0.01). The sensitivity, specificity, negative likelihood ratio and positive likelihood ratio for S+vs. S–samples were 76.6 % vs. 73.9 %, 100 % vs. 100 % and 0.23 vs. 0.26, NA vs NA, respectively. A negative impact of blood contamination in the overall diagnostic yield wasn’t seen, even in samples where suction was used (OR 0.36, P = 0.15) Conclusions We found a higher diagnostic yield with the use of suction. It was associated with a higher degree of sample blood contamination that did not affect the diagnostic performance.

scholarly journals Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study

2019 ◽  
Vol 07 (07) ◽  
pp. E931-E936 ◽  
Author(s):  
Arvind J. Trindade ◽  
Petros C. Benias ◽  
Mohammed Alshelleh ◽  
Ahmad N. Bazarbashi ◽  
Benjamin Tharian ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Biopsy ◽  
Gastrointestinal Stromal Tumors ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Stromal Tumors

Abstract Background and study aims There are numerous studies published on the diagnostic yield of the new fine-needle biopsy (FNB) needles in pancreas masses. However, there are limited studies in suspected gastrointestinal stromal tumors (GIST lesions). The aim of this study was to evaluate the diagnostic yield of a new fork-tip FNB needle. Patients and methods This was a multicenter retrospective study of consecutive patients from prospectively maintained databases comparing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided FNB (EUS-FNB) using the fork-tip needle. Outcomes measured were cytopathology yield (ability to obtain tissue for analysis of cytology), ability to analyze the tissue for immunohistochemistry (IHC yield), and diagnostic yield (ability to provide a definitive diagnosis). Results A total of 147 patients were included in the study of which 101 underwent EUS-FNB and 46 patients underwent EUS-FNA. Median lesion size in each group was similar (21 mm vs 25 mm, P = 0.25). Cytopathology yield, IHC yield, and diagnostic yield were 92 % vs 46 % (P = 0.001), 89 % vs 41 % (P = 0.001), and 89 % vs 37 % (P = 0.001) between the FNB and FNA groups, respectively. Median number of passes was the same between the two groups at 3.5. Conclusion EUS-FNB is superior to EUS-FNA for diagnostic yield of suspected GIST lesions. This should be confirmed with a prospective study.

Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Author(s):  
Priscilla A. van Riet ◽  
Nicole S. Erler ◽  
Marco J. Bruno ◽  
Djuna L. Cahen
Keyword(s):  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Biopsy ◽  
Meta Analysis ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Systemic Review ◽  
Sampling Device ◽  
Fine Needle

Abstract Background Endoscopic ultrasound (EUS)-guided tissue acquisition is extensively used, but the optimal sampling device is still a matter of debate. We performed meta-analyses on studies comparing fine-needle aspiration (FNA) with fine-needle biopsy (FNB) needles, and studies comparing different FNB needles. Methods Online databases were searched for randomized controlled trials (RCTs) of at least 50 cases with a suspected solid pancreatic or nonpancreatic lesion that compared FNA with FNB needles. Outcome measures included diagnostic accuracy, adequacy, number of passes, presence of tissue cores, and adverse events. We also performed meta-regression analysis on the effect of FNB design on diagnostic accuracy. Quality was assessed using the QUADAS-2 tool. Results 18 RCTs comparing FNA with FNB needles were included. FNB provided a higher pooled diagnostic accuracy (87 % vs. 80 %; P = 0.02) and tissue core rate (80 % vs. 62 %; P = 0.002), and allowed diagnosis with fewer passes (P = 0.03), in both pancreatic and nonpancreatic lesions. A total of 93 studies were included comparing different FNB devices. Pooled diagnostic accuracy was higher for forward-facing bevel needles than for the reverse bevel needle. In this analysis, study quality was low and heterogeneity was high (I2  = 80 %). Conclusion FNB outperformed FNA when sampling pancreatic and nonpancreatic lesions. Forward-facing bevel FNB needles seemed to outperform the reverse bevel FNB needle, but the low quality of evidence prevents us from making strong recommendations on the optimal FNB design.

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