Reliability of grading preoperative pancreatic neuroendocrine tumors on EUS specimens: a systematic review with meta-analysis of aggregate and individual data,Gastrointestinal Endoscopy

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Reliability of grading preoperative pancreatic neuroendocrine tumors on EUS specimens: a systematic review with meta-analysis of aggregate and individual data
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2022-07-19 , DOI: 10.1016/j.gie.2022.07.014
Matteo Tacelli ₁ , Niccolò Bina ₂ , Stefano Francesco Crinò ₃ , Antonio Facciorusso ₄ , Ciro Celsa ₅ , Andrea Sbrozzi Vanni ₆ , Alberto Fantin ₇ , Filippo Antonini ₈ , Massimo Falconi ₉ , Fabio Monica ₁₀ , Gabriele Capurso ₁₁ , Paolo Giorgio Arcidiacono ₁ , Luca Barresi ₁₂ ,

Affiliation

Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.
Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy.
Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy.
Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.
Gastroenterology and Diagnostic and Operative Digestive Endoscopy, San Camillo Forlanini Hospital, Rome, Italy.
Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
Gastroenterology and Digestive Endoscopy Unit, Augusto Murri Hospital, Polytechnic University of Marche, Fermo, Italy.
Vita-Salute San Raffaele University, Milan, Italy; Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy.
Gastroenterology and Digestive Endoscopy, "Cattinara" Academic Hospital, Trieste, Italy.
Division of Pancreato-Biliary Endoscopy and EUS, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy.
Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy.

Background and Aims

Therapy and prognosis of pancreatic neuroendocrine tumors (PanNETs) are strictly related to the Ki-67 index, which defines tumor grading. The criterion standard for the assessment of grading of PanNETs is EUS-guided FNA (EUS-FBAFNA) or EUS-guided fine-needle biopsy sampling (EUS-FNB). Because data on diagnostic accuracy of EUS-FNA and EUS-FNB are heterogeneous, we aimed to analyze the variability in concordance between EUS grading and surgical grading.

Methods

The MEDLINE, SCOPUS, and EMBASE databases were searched until November 2021 to identify studies reporting the concordance rate between EUS grading and surgical grading. The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled events were calculated using a random-effects model and expressed in terms of pooled prevalence rates. A multivariate meta-regression was performed to find possible sources of heterogeneity. Where available, individual data were analyzed.

Results

Twenty-six studies with 864 patients undergone EUS-FNA or EUS-FNB and surgical resection for PanNETs were included. The pooled estimate rate for the overall concordance of EUS grading and surgical grading was 80.3% (95% confidence interval, 75.6-85.1). Undergrading (EUS grading < surgical grading) was significantly more frequent with respect to overgrading (14.7% vs 3.5%, P < .001). Individual data analysis showed that among nonconcordant patients, the median Ki-67 difference was 3% (interquartile range, 2-6.15). The type of World Health Organization classification adopted and the median lesion diameter were significantly associated with heterogeneity at meta-regression.

Conclusions

EUS is an accurate technique in defining grading in patients with PanNETs, but a margin of error still exists, which should be the focus of future studies to minimize the risk of over- and/or undertreatment.

中文翻译：

EUS 标本术前胰腺神经内分泌肿瘤分级的可靠性：对总体和个体数据进行荟萃分析的系统评价

背景和目标

胰腺神经内分泌肿瘤 (PanNETs) 的治疗和预后与定义肿瘤分级的 Ki-67 指数密切相关。PanNETs分级评估的标准是EUS引导的FNA（EUS-FBAFNA）或EUS引导的细针活检取样（EUS-FNB）。由于 EUS-FNA 和 EUS-FNB 的诊断准确性数据存在异质性，我们旨在分析 EUS 分级和手术分级之间一致性的变异性。

方法

搜索了 MEDLINE、SCOPUS 和 EMBASE 数据库，直到 2021 年 11 月，以确定报告 EUS 分级和手术分级之间一致性的研究。该研究是根据系统评价和荟萃分析指南的首选报告项目进行的。使用随机效应模型计算汇总事件，并以汇总流行率表示。进行多元元回归以寻找异质性的可能来源。在可用的情况下，对个别数据进行了分析。

结果

纳入了 26 项研究，其中 864 名患者接受了 EUS-FNA 或 EUS-FNB 以及针对 PanNETs 的手术切除。EUS 分级和手术分级的总体一致性的汇总估计率为 80.3%（95% 置信区间，75.6-85.1）。低分级（EUS 分级 < 手术分级）明显高于高分级（14.7% 对 3.5%，P < .001）。个体数据分析表明，在不一致的患者中，Ki-67 差异的中位数为 3%（四分位间距，2-6.15）。采用的世界卫生组织分类类型和中位病变直径与元回归的异质性显着相关。