Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis

Abstract

Background and study aims There is limited evidence on the diagnostic performance of endoscopic ultrasound (EUS)-guided tissue acquisition in autoimmune pancreatitis (AIP). The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) in patients with AIP. Patients and methods Computerized bibliographic search was performed through January 2020. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy compared to clinical diagnostic criteria. Additional outcomes were definitive histopathology, pooled rates of adequate material for histological diagnosis, sample adequacy, mean number of needle passes. Diagnostic sensitivity and safety data were also analyzed. Results Fifteen studies with 631 patients were included, of which four were prospective series and one randomized trial. Overall diagnostic accuracy of EUS tissue acquisition was 54.7 % (95 % confidence interval, 40.9 %–68.4 %), with a clear superiority of FNB over FNA (63 %, 52.7 % to 73.4 % versus 45.7 %, 26.5 %–65 %; p < 0.001). FNB provided level 1 of histological diagnosis in 44.2 % of cases (30.8 %–57.5 %) as compared to 21.9 % (10 %–33.7 %) with FNA (P < 0.001). The rate of definitive histopathology of EUS tissue sampling was 20.7 % (12.9 %–28.5 %) and it was significantly higher with FNB (24.3 %, 11.8 %–36.8 %) as compared to FNA (14.7 %, 5.4 %–23.9 %; P < 0.001). Less than 1 % of subjects experienced post-procedural acute pancreatitis. Conclusion The results of this meta-analysis demonstrate that the diagnostic performance of EUS-guided tissue acquisition is modest in patients with AIP, with an improved performance of FNB compared to FNA.

The Role of EUS-Guided FNA and FNB in Autoimmune Pancreatitis

“…In recent years, new FNB needles have been developed to maintain tissue architecture in samples [37]. These needles showed better results in achieving a histological diagnosis of AIP than FNA [38]. Side-fenestrated needles appear to be less accurate in the diagnosis compared with front-cutting needles, such as Franseen and Fork-tip needles, which showed level 1 histology in approximately 56-72% of cases.…”

Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study

“…Comparative results based on studies using newer FNB needles are still scarce. In fact, the Franseen and Fork-tip needles, characterized by a surface with multiple cutting points designed to provide improved control at the puncture site and stability at the tip allowing for enhanced penetration, showed very promising results in other abdominal masses [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. However, definitive assumptions of their comparative performance in the case of LN sampling cannot be drawn.…”

“…In the last years, a paradigm shift towards increased use of fine-needle biopsy (FNB) was observed in clinical practice [ 11 ]. The promising results observed with newer FNB needles, such as the Franseen needle (Acquire ® [Boston Scientific, Marlborough, MA, USA]) and the Fork-tip needle (SharkCore ® [Medtronic, Dublin, Ireland]), in tissue acquisition of pancreatic masses and of subepithelial lesions require confirmation also in the setting of LN biopsy [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Endoscopic ultrasound‐guided pancreatic sampling for the histopathological diagnosis of autoimmune pancreatitis

“…Two systematic reviews reported establishing the histological diagnosis of AIP using EUS-FNA and EUS-FNB. 30,31 Facciorusso et al compiled data on 631 cases in 15 reports with a diagnostic accuracy of 54.7% (95% confidence interval [CI] 40.9-68.4%) for the histologic diagnosis of AIP by EUS-FNB, which was significantly higher than the rate of 45.7% (95% CI 26.5-65%) reported using EUS-FNA. 30 Yoon et al compiled data on 440 cases from nine reports to determine an overall diagnostic accuracy of 87.2% (95% CI 68.8-98.1%) for the histologic diagnosis of AIP using EUS-FNB, which was significantly higher than the rate of 55.8% (95% CI 37.0-73.9%) reported for EUS-FNA.…”

“…30,31 Facciorusso et al compiled data on 631 cases in 15 reports with a diagnostic accuracy of 54.7% (95% confidence interval [CI] 40.9-68.4%) for the histologic diagnosis of AIP by EUS-FNB, which was significantly higher than the rate of 45.7% (95% CI 26.5-65%) reported using EUS-FNA. 30 Yoon et al compiled data on 440 cases from nine reports to determine an overall diagnostic accuracy of 87.2% (95% CI 68.8-98.1%) for the histologic diagnosis of AIP using EUS-FNB, which was significantly higher than the rate of 55.8% (95% CI 37.0-73.9%) reported for EUS-FNA. 31 After collecting and analyzing data on 617 cases in 20 reports, Chhoda et al demonstrated that the rate of collecting a sufficient amount of tissue (FNB vs. FNA = 96.8% vs. 79.8%, P = 0.016) and accurate diagnosis rate (FNB vs. FNA = 60.20% vs. 42.02%, P < 0.0001) were superior using EUS-FNB.…”