Comparative diagnostic accuracy of EUS needles in solid pancreatic masses: a network meta-analysis

Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided tissue sampling is the standard of care for diagnosing solid pancreatic lesions. While many two-way comparisons between needle types have been made in randomized controlled trials (RCTs), it is unclear which size and type of needle offers the best probability of diagnosis. We therefore performed a network meta-analysis (NMA) to compare different sized and shaped needles to rank the diagnostic performance of each needle. Methods We searched MEDLINE, EMBASE and Cochrane Library databases through August, 2020 for RCTs that compared the diagnostic accuracy of EUS fine-needle aspiration (FNA) and biopsy (FNB) needles in solid pancreatic masses. Using a random-effects NMA under the frequentist framework, RCTs were analyzed to identify the best needle type and sampling technique. Performance scores (P-scores) were used to rank the different needles based on pooled diagnostic accuracy. The NMA model was used to calculate pairwise relative risk (RR) with 95 % confidence intervals. Results Review of 2577 studies yielded 29 RCTs for quantitative synthesis, comparing 13 different needle types. All 22G FNB needles had an RR > 1 compared to the reference 22G FNA (Cook) needle. The highest P-scores were seen with the 22G Medtronic FNB needle (0.9279), followed by the 22G Olympus FNB needle (0.8962) and the 22G Boston Scientific FNB needle (0.8739). Diagnostic accuracy was not significantly different between needles with or without suction. Conclusions In comparison to FNA needles, FNB needles offer the highest diagnostic performance in sampling pancreatic masses, particularly with 22G FNB needles.

Optimal sampling technique for EUS-guided fine-needle biopsy of solid pancreatic lesions using a 25-gauge ProCore needle: A multicenter randomized crossover superiority study

“…[ 26 ] Moreover, 90.72% of the tissue specimens acquired with the 25G ProCore needle were adequate for immunohistochemical staining, so that neoplastic diseases could be specifically diagnosed. Furthermore, in previous studies involving 22G needles, a lower diagnostic accuracy was often observed for lesions located in the head and uncinate or those with diameters <2 cm,[ 10 12 19 27 ] but this was not the case in the present study. According to the multivariate analysis, a mass measuring smaller than 2 cm was even significantly associated with a higher diagnostic sensitivity in the SS group.…”

“…Compared to a 19G or 22G needle, the 25G needle has a smaller diameter and higher flexibility, which might lead to a higher technical success rate and wider applicability, especially in the head/uncinate of the pancreas. [ 19 ] However, the actual suction force applied at the 25G needle tip can be weakened as the needle diameter and syringe aspiration volume decreased. [ 20 ] Besides, so far, no prospective clinical trial has tested the efficacy of these three techniques for solid pancreatic lesions using a 25G ProCore needle in one trial.…”

Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

“…Peter Vilmann first performed EUS-TA for the cytologic diagnosis of a pancreatic lesion in 1991 [ 18 ].This technique has now become the standard method for tissue acquisition from pancreatic and peripancreatic lesions [ 14 , 19 ]. A recent network meta-analysis demonstrated better accuracy with 22-gauge FNB needles than conventional 22-gauge FNA needles [ 20 ], but it did not compare the performance between different types of FNB needles, namely, side-fenestrated needles, Franseen-tip needles, and Fork-tip needles. About this issue, another network meta-analysis in 2022 demonstrated the higher accuracy of Franseen-tip needles and Fork-tip needles than reverse-bevel needles and conventional FNA needles [ 21 , 22 ], especially in the absence of ROSE [ 3 ].…”

Endoscopic Ultrasound Guided Fine Needle Aspiration versus Endoscopic Ultrasound Guided Fine Needle Biopsy for Pancreatic Cancer Diagnosis: A Systematic Review and Meta-Analysis

“…Similarly, Van Rietet al included 14 randomized controlled trials on cancerous and non-cancerous lesions and found that the EUS-FNB was superior to EUS-FNA (diagnostic accuracy 87% vs. 80%, p = 0.002) [ 8 ]. Finally, a network meta-analysis by deHan et al, including cancerous and non-cancerous lesions also showed that EUS-FNB was superior to EUS-FNA [ 9 ].…”

“…Diagnostic accuracy is the primary outcome in most studies comparing the yield of different needle types. The diagnostic accuracy of FNA needles for pancreatic cancer is generally lower than for FNB needles [ 6 , 7 , 8 , 9 ]. The aim of this systematic review and meta-analysis was to compare the diagnostic yield of EUS-FNA cytology needles with that of the various EUS-FNB needles.…”