Endoscopic Ultrasound Guided Fine-Needle Aspiration for Solid Lesions in Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Abdallah, Mohamed; Ahmed, Khalid; Taha, Wesam; Musa, Abdullahi; Reardon, Erin E.; Abdalla, Abubaker; Trikudanathan, Guru

doi:10.1007/s10620-021-07066-3

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…The diagnostic accuracy achieved in our study is consistent with the results published in international studies and high-quality meta-analyses, with a pooled sensitivity of 84-89% and a specificity of 96-99% [3,11,12]. However, the diagnostic efficacy of the method for solid nodules in chronic pancreatitis are significantly lower: sensitivity 65% (52.6-75.6%) and specificity 96.8% (75-99.7%), respectively [13]. Despite the convincing data, the NPV of EUS-FNA for suspected pancreatic tumors is considered low, and in our study it was also barely above 50%; furthermore, the inconclusive (atypical cells, suspicious for malignancy), negative for malignancy, or nondiagnostic results do not allow the definitive diagnosis of the benign conditions.…”

Section: Discussionsupporting

confidence: 89%

Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions

Bor,

Vasas,

Fábián

et al. 2023

Diagnostics

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Background: The inconclusive cytological findings of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remain a major clinical challenge and often lead to treatment delays. Methods: Patients who had undergone EUS-FNA sampling for solid pancreas lesions between 2014 and 2021 were retrospectively enrolled. The “atypical” and “non-diagnostic” categories of the Papanicolaou Society of Cytopathology System were considered inconclusive and the “negative for malignancy” category of malignancy was suspected clinically. We determined the frequency and predictors of inconclusive cytological finding. Results: A total of 473 first EUS-FNA samples were included, of which 108 cases (22.83%) were inconclusive. Significant increases in the odds of inconclusive cytological findings were observed for lesions with a benign final diagnosis (OR 11.20; 95% CI 6.56–19.54, p < 0.001) as well as with the use of 25 G FNA needles (OR 2.12; 95% CI 1.09–4.01, p = 0.023) compared to 22 G needles. Furthermore, the use of a single EUS-FNA technique compared to the combined use of slow-pull and standard suction techniques (OR 1.70; 95% CI 1.06–2.70, p = 0.027) and less than three punctures per procedure led to an elevation in the risk of inconclusive cytology (OR 2.49; 95% CI 1.49–4.14, p < 0.001). Risk reduction in inconclusive cytology findings was observed in lesions between 2–4 cm (OR 0.40; 95% CI 0.23–0.68, p = 0.001) and >4 cm (OR 0.16; 95% CI 0.08–0.31, p < 0.001) compared to lesions ≤2 cm. Conclusions: The more than two punctures per EUS-FNA sampling with larger-diameter needle (19 G or 22 G) using the slow-pull and standard suction techniques in combination may decrease the probability of inconclusive cytological findings.

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Section: Discussionsupporting

confidence: 89%

Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions

Bor,

Vasas,

Fábián

et al. 2023

Diagnostics

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“…Endoscopic ultrasound-guided tissue acquisition (EUS-TA), encompassing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and biopsy (EUS-FNB), is pivotal for diagnosing pancreatic solid lesions, with studies reporting 69–95% diagnostic sensitivity and minimal complication rates (0–2%) [ 1 , 2 , 3 , 4 , 5 ]. Despite its established reliability and safety [ 6 ], EUS-TA’s diagnostic accuracy depends on factors like sampling methods, needle types, endosonographer expertise, and the availability of rapid on-site evaluation (ROSE) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Rapid On-Line Evaluation (ROLE) Protocol in the Diagnostic Performance Improvement in Endoscopic Ultrasound-Guided Tissue Acquisition for Solid Pancreatic Lesions

Cai,

Rao,

Zhang

et al. 2024

Diagnostics

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We assessed the rapid on-line evaluation (ROLE) protocol as a modification to the conventional rapid on-site evaluation (ROSE) in the diagnostic performance improvement in endoscopic ultrasound-guided tissue acquisition (EUS-TA) for solid pancreatic lesions. This single-center, retrospective study involved consecutive patients with solid pancreatic lesions undergoing EUS-TA at Peking University First Hospital between October 2017 and March 2021. Among 137 patients enrolled, 75 were in the ROLE group and 62 were in the non-ROSE group. The diagnostic yield (97.3% vs. 85.5%, p = 0.023), accuracy (94.7% vs. 82.3%, p = 0.027), and sensitivity (95.7% vs. 81.1%, p = 0.011) were significantly higher in the ROLE group compared to the non-ROSE group. However, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) showed no significant differences (all p-values > 0.05). Additionally, there was a noteworthy reduction in the number of needle passes required in the ROLE group compared to the non-ROSE group (two vs. three, p < 0.001). In a subgroup analysis, fine needle biopsy (FNB) combined with ROLE demonstrated superior diagnostic accuracy compared to FNB with non-ROSE (100% vs. 93.1%, p = 0.025). Compared with the non-ROSE protocol, the ROLE protocol might improve the diagnostic performance of EUS-TA for solid pancreatic lesions, and potentially reduce the number of needle passes requirement.

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“…As a result, fine‐needle biopsy (FNB) has been increasingly used to obtain tissue for potential molecular testing 11 . However, fine‐needle aspiration (FNA) remains the method of choice for sampling pancreatic lesions because it has high diagnostic accuracy and a very low complication rate 12,13 . Not infrequently, FNA specimens are the only material available for additional studies.…”

Section: Introductionmentioning

confidence: 99%

“…11 However, fine-needle aspiration (FNA) remains the method of choice for sampling pancreatic lesions because it has high diagnostic accuracy and a very low complication rate. 12,13 Not infrequently, FNA specimens are the only material available for additional studies. Some recent studies have suggested the feasibility of FNA material for comprehensive molecular testing.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive molecular profiling of pancreatic ductal adenocarcinoma in FNA, biopsy, and resection specimens

Razzano

Bouza

Hernandez

et al. 2022

Cancer Cytopathology

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BACKGROUND Molecular testing to identify molecular alterations in pancreatic ductal adenocarcinoma (PDAC) has been increasingly requested because of potential therapeutic implications. In this study, we compared the performance of PDAC fine‐needle aspiration (FNA), fine‐needle biopsy (FNB), and resection specimens for comprehensive molecular analysis. METHODS A next‐generation sequencing–based Oncomine Comprehensive Assay (OCA) was used to analyze molecular alterations in FNA, FNB, or resection specimens. We examined adequacy and success rates for completion of molecular testing and catalogued molecular alterations in these specimen types. RESULTS The cohort included 23 FNA, 20 FNB, and 27 resection cases. Gene mutation or amplification analysis was successful in 18 (78%) FNA and 16 (80%) FNB specimens, whereas gene fusion assessment succeeded in 12 (52%) FNA and 12 (60%) FNB samples. All 27 (100%) resection specimens were adequate for complete OCA. There were significant differences in success rates for mutation and amplification analysis between resection and FNA or FNB specimens (P < .01) but not between FNA and FNB samples (P > .05). Manual microdissection was less likely to be performed for FNA specimens than FNB or resection specimens (P < .01). KRAS mutation was the most common mutation identified (90%), followed by mutations in TP53 (64%), CDKN2A (25%), and SMAD4 (15%) genes. CONCLUSIONS Our study demonstrated similar success rates for comprehensive molecular analysis using FNA and FNB specimens of PDAC, suggesting that FNA material could serve as an alternative source for comprehensive molecular testing. The molecular alterations identified in these specimens may have potential diagnostic and therapeutic implications.;

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Endoscopic Ultrasound Guided Fine-Needle Aspiration for Solid Lesions in Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 22 publications

Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions

Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions

A Rapid On-Line Evaluation (ROLE) Protocol in the Diagnostic Performance Improvement in Endoscopic Ultrasound-Guided Tissue Acquisition for Solid Pancreatic Lesions

Comprehensive molecular profiling of pancreatic ductal adenocarcinoma in FNA, biopsy, and resection specimens

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