Background and Aims

Variable diagnostic performance of sampling techniques during EUS-guided tissue acquisition of solid pancreatic masses based on needle type (FNA versus fine-needle biopsy [FNB]) and gauge (19-gauge vs 22-gauge vs 25-gauge) has been reported. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of EUS-guided techniques for sampling solid pancreatic masses.

Methods

Through a systematic literature review to November 2018, we identified 27 randomized controlled trials (2711 patients) involving adults undergoing EUS-guided sampling of solid pancreatic masses that evaluated the diagnostic performance of FNA and FNB needles based on needle gauge. The primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, histologic core procurement rate, and number of needle passes. We performed pairwise and network meta-analyses and appraised the quality of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.

Results

In the network meta-analysis, no specific EUS-guided tissue sampling technique was superior, based on needle type (FNA vs FNB) or gauge (19-gauge vs 22-gauge vs 25-gauge) (low-quality evidence). Specifically, there was no difference between 25-gauge FNA versus 22-gauge FNA (relative risk [RR], 1.03; 95% confidence interval [CI], 0.91-1.17) and 22-gauge FNB versus 22-gauge FNA (RR, 1.03; 95% CI, 0.89-1.18) needles for diagnostic accuracy, sample adequacy, and histologic core procurement. Findings were confirmed in sensitivity analysis restricted to studies with no rapid on-site cytologic evaluation and no use of the fanning technique.

Conclusion

In a network meta-analysis, no specific EUS-guided tissue sampling technique was superior with regard to diagnostic accuracy, sample adequacy, or histologic procurement rate for solid pancreatic masses, with low confidence in estimates.

中文翻译：

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实体胰块EUS组织取样的针头尺寸和设计的比较准确性：网络荟萃分析。

背景和目标

据报道，在EUS指导的实体胰腺肿块的EUS引导的组织采集过程中，采样技术的可变诊断性能基于针的类型（FNA与细针穿刺活检[FNB]）和规格（19规格vs 22规格vs 25规格）。我们进行了网络荟萃分析的系统评价，比较了EUS指导的固体胰腺肿块采样技术的诊断准确性。

方法

通过至2018年11月的系统文献综述，我们确定了27项随机对照试验（2711例患者），涉及成年人接受EUS指导的固体胰腺肿块取样，并根据针规评估了FNA和FNB针的诊断性能。主要结果是诊断准确性。次要结果是样本充足，组织学核心采购率和穿刺次数。我们进行了成对的和网络的荟萃分析，并使用GRADE（建议评估，发展和评估等级）方法评估了证据的质量。

结果

在网络荟萃分析中，基于针型（FNA vs FNB）或针规（19规vs 22规vs 25规）（低质量证据）的方法，没有任何特定的EUS指导的组织采样技术优越。具体而言，25规格FNA与22规格FNA（相对风险[RR]为1.03； 95％置信区间[CI]为0.91-1.17）和22规格FNB与22规格FNA之间没有差异（RR， 1.03; 95％CI，0.89-1.18）针，可提高诊断准确性，样品充足性和组织学核心采购。敏感性分析中的发现被确认为仅限于研究，没有快速的现场细胞学评估，也没有使用扇动技术。

结论

在网络荟萃分析中，没有任何具体的EUS指导的组织采样技术在诊断准确度，样品充分性或固体胰腺肿块的组织学获取率方面具有优越性，并且对估计值的置信度较低。