Endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions: A systematic review of technical and procedural variables

Jani, Bhairvi; Rzouq, Fadi; Saligram, Shreyas; Lim, Diego; Rastogi, Amit; Bonino, John; Olyaee, Mojtaba

doi:10.4103/1947-2714.175185

Cited by 39 publications

(17 citation statements)

References 104 publications

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“…The best scientific evidence currently available is from a large meta-analysis based on 33 studies 8 that showed that the EUS-FNA method obtained a sensitivity of 85% to 91%, specificity of 94% to 98%, and positive predictive value of 98% to 99%, independent of the needle used for the diagnosis of pancreatic lesions. These results are in accordance with those derived from the present study, and they support the recommendation to use EUS-FNA in the case of pancreatic lesions, as EUS-FNA provides a high pre-test probability for malignancy and negative histopathological diagnosis 11 , 34 , 35 .…”

Section: Discussionsupporting

confidence: 92%

“…The discrepancy in the literature shows that needle selection is a complex process that depends on several factors, such as lesion morphology and location, presence of a cytopathologist in the room, and preferences of the endoscopist 11 .…”

Section: Discussionmentioning

confidence: 99%

“…The 25G needle, because of its flexibility, may present benefits compared with larger needles used for EUS-FNA at more difficult access sites, such as the pancreatic head, uncinate process and proximal region of the bile duct 11 . For example, one study reported a failure to puncture in 33% of cases with lesions located at the uncinate process 12 .…”

Section: Introductionmentioning

confidence: 99%

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A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Guedes¹,

Moura²,

Duarte³

et al. 2018

Clinics

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Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Guedes¹,

Moura²,

Duarte³

et al. 2018

Clinics

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“…Compared to other interventional procedures like ERCP, EUS-FNA procedures are very safe with reported overall complication rates ranging from 0.3% to 2.2%[ 64 , 65 ]. Smaller (≤ 20 mm) and pancreatic neuroendocrine lesions were associated with increased risk of complications including pancreatitis, abdominal pain, and bleeding in a retrospective single center study[ 66 ].…”

Section: Potential Adverse Eventsmentioning

confidence: 99%

Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

Storm¹,

Lee²

2016

WJG

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The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions.

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“…There is no evidence in the literature demonstrating superiority of the techniques of aspiration suction, use or not of the stylet, or “slow pull.”[ 36 39 40 41 42 43 44 ]…”

Section: Resultsmentioning

confidence: 99%

II Brazilian consensus statement on endoscopic ultrasonography

et al. 2017

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Background and Objectives:At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions.Methods:From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on.Results:Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts.Conclusions:There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the safest method; unilateral and bilateral injection techniques are equivalent for EUS-guided celiac neurolysis, and in patients with visible ganglia, celiac ganglia neurolysis appears to lead to better results. There is a moderate level of evidence for: yield of tissue sampling of pancreatic solid lesions is not influenced by the needle shape, gauge, or employed aspiration technique; EUS-guided and percutaneous biliary drainage present similar clinical success and adverse event rates; plastic and metallic stents are equivalent in the EUS-guided treatment of pancreatic pseudocyst. There is a low level of evidence in the routine use of EUS-guided treatment of gastric varices.

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Endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions: A systematic review of technical and procedural variables

Cited by 39 publications

References 104 publications

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

II Brazilian consensus statement on endoscopic ultrasonography

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