Background and Aims

There is currently limited evidence supporting the use of EUS-guided through-the-needle biopsy for sampling pancreatic cystic lesions. The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of through-the-needle biopsy for sampling of pancreatic cysts.

Methods

A bibliographic search on the main databases was performed in September 2019. Pooled effects were calculated using a random-effects model by means of the DerSimonian and Laird test. The primary outcome was sample adequacy. Additional endpoints were diagnostic accuracy, optimal histologic core procurement, mean number of needle passes, pooled specificity, and sensitivity. Adverse event rates were also analyzed.

Results

Eleven studies enrolling 490 patients were included. Eight articles compared through-the-needle biopsy with cytology/cystic fluid analysis. Most patients were female, and the body/tail was the most frequent location of cystic lesions. Sample adequacy with through-the-needle biopsy was 85.3% (78.2%-92.5%), and subanalysis performed according to cyst morphology, size, and location confirmed the result. Through-the-needle biopsy clearly outperformed FNA both in terms of sample adequacy (odds ratio, 4.83; 95% confidence interval, 1.63-14.31; P =.004) and diagnostic accuracy (odds ratio, 3.44; 95% confidence interval, 1.32-8.96; P =.01). The pooled diagnostic accuracy rate, sensitivity, and specificity of through-the-needle biopsy were 78.8%, 82.2%, and 96.8%, respectively. A mean of 3.121 (2.98-3.25) passes through the cyst was needed to obtain adequate histologic samples. The incidence rates of mild bleeding and pancreatitis were 4% and 2%, respectively.

Conclusion

Our meta-analysis speaks in favor of the use of through-the-needle biopsy as a safe and effective tool in EUS-guided tissue acquisition of pancreatic cysts.

中文翻译：

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EUS指导的胰腺囊肿穿刺活检的诊断率：一项荟萃分析。

背景和目标

目前，仅有有限的证据支持使用EUS引导的穿刺活检来采集胰腺囊性病变。这项荟萃分析的目的是提供通过穿刺活检对胰腺囊肿取样的诊断性能的综合评估。

方法

在2019年9月对主要数据库进行了书目搜索。通过DerSimonian和Laird检验，使用随机效应模型计算合并效应。主要结果是样本充足。其他终点是诊断准确性，最佳组织学核心获取，平均穿刺次数，合并的特异性和敏感性。还分析了不良事件发生率。

结果

纳入了490名患者的11项研究。八篇文章比较了穿刺活检与细胞学/囊性液分析。大多数患者是女性，身体/尾巴是囊性病变最常见的位置。穿刺穿刺活检的样本合格率为85.3％（78.2％-92.5％），根据囊肿的形态，大小和位置进行的亚分析证实了结果。整个针刺活检在样本量（赔率，4.83； 95％置信区间，1.63-14.31；P  = .004）和诊断准确性（赔率，3.44； 95％置信区间，1.32）方面均明显优于FNA 。 -8.96; P = .01）。穿刺活检的综合诊断准确率，敏感性和特异性分别为78.8％，82.2％和96.8％。需要平均3.121（2.98-3.25）穿过囊肿才能获得足够的组织学样本。轻度出血和胰腺炎的发生率分别为4％和2％。

结论

我们的荟萃分析表明，在EUS指导的胰腺囊肿组织采集中，穿刺活检是一种安全有效的工具。