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

Abstract

Introduction: One of the most effective diagnostic tools for pancreatic cancer is endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or biopsy (EUS-FNB). Several randomized clinical trials have compared different EUS tissue sampling needles for the diagnosis of pancreatic cancer. Objective: To compare the diagnostic accuracy of EUS-guided FNA as EUS-FNB needles for the diagnosis of pancreatic cancer using a systematic review and meta-analysis. Method: A literature review with a meta-analysis was performed according to the PRISMA guide. The databases of PubMed, Cochrane and Google Scholar were used, including studies published between 2011–2021 comparing the diagnostic yield (diagnostic accuracy or probability of positivity, sensitivity, specificity, predictive value) of EUS-FNA and EUS-FNB for the diagnosis of pancreatic cancer. The primary outcome was diagnostic accuracy. Random effect models allowed estimation of the pooled odds ratio with a confidence interval (CI) of 95%. Results: Nine randomized control trials were selected out of 5802 articles identified. Among these, five studies found no statistically significant difference between the EUS-FNA and EUS-FNB, whereas the other four did. The meta-analysis found EUS-FNB accuracy superior to EUS-FNA for the diagnosis of pancreatic cancer with a pooled odds ratio of 1.87 (IC 95%: 1.33–2.63). Conclusion: As compared to EUS-FNA, EUS-FNB seems to improve diagnostic accuracy when applied to suspicious pancreatic lesions.

Endoscopic Ultrasound-Guided Tissue Sampling for the Cytohistological Diagnosis of Focal Liver Lesions

“…These needles provide samples that are adequate for histological, immunohistochemical, and molecular evaluation. Core needles have been shown to be superior to standard cytology needles in the evaluation of solid pancreatic lesions [ 23 ] and parenchymal liver disease [ 24 ]. Furthermore, a recent study has shown that core needles yield more adequate samples than FNA needles for the evaluation of focal liver lesions [ 25 ].…”

Role of Endoscopic Ultrasound in Pancreatic Cancer Diagnosis and Management

“…Additionally, while multiple studies have shown that FNA biopsies provide an adequate yield, the NCCN guidelines recommend the use of newer-generation core FNB needles [ 11 , 30 ]. In a systematic review by Hassan and colleagues of nine randomized controlled trials, EUS–FNB was superior to EUS–FNA for diagnosing pancreatic cancer (OR 1.87) [ 31 ]. Furthermore, FNB specimens provide adequate core tissue for histologic purposes, facilitating next-generation sequencing and molecular profiling for precision medicine.…”

Diagnostic Endoscopic Ultrasound in Pancreatology: Focus on Normal Variants and Pancreatic Masses

“…Smaller needles may be more easily directed to a target lesion, particularly in lesion located deep in the GI tract. A recent meta-analysis showed that EUS fine-needle biopsy was more accurate than EUS-FNA (where cytology only is evaluated) to diagnose pancreatic cancer [107, 108] and non-pancreatic lesion [109]. Among fine-needle biopsy needles, Franseen and fork-tip needles showed the highest performance for tissue sampling in the evaluation of pancreatic masses [109, 110].…”