The diagnostic and cellularity yield of reverse bevel versus fork‐tip fine needle biopsy

Abdelfatah, Mohamed M.; Hamed, Ahmed; Koutlas, Nicholas J.; Aly, Fatima Zahra

doi:10.1002/dc.23966

Cited by 10 publications

(8 citation statements)

References 18 publications

(25 reference statements)

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“…Finally, 24 studies 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 with 6641 patients were included in the meta-analysis. Main characteristics of included studies are reported in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Diagnostic yield of Franseen and Fork-Tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis

et al. 2019

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Background and study aims Although newer needle designs are thought to improve diagnostic outcomes of endoscopic ultrasound-guided fine-needle biopsy, there is limited evidence on their diagnostic performance. The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance and safety profile of Franseen and Fork-tip fine-needle biopsy needles. Patients and methods Computerized bibliographic search on the main databases was performed through March 2019. The primary endpoint was sample adequacy. Secondary outcomes were diagnostic accuracy, optimal histological core procurement, mean number of needle passes, pooled specificity and sensitivity. Safety data were also analyzed. Results Twenty-four studies with 6641 patients were included and pancreas was the prevalent location of sampled lesions. Overall sample adequacy with the two newer needles was 94.8 % (93.1 % – 96.4 %), with superiority of Franseen needle over Fork-tip (96.1 % versus 92.4 %, P < 0.001). Sample adequacy in targeting pancreatic masses was 95.6% and both needles produced results superior to fine-needle aspiration (FNA) (odds ratio 4.29, 1.49 – 12.35 and 1.79, 1.01 – 3.19 with Franseen and Fork-tip needle, respectively). The rate of histological core procurement was 92.5%, whereas diagnostic accuracy and sensitivity were 95 % and 92.8 %, again with no difference between the two needles. Number of needle passes was significantly lower in comparison to FNA (mean difference: –0.42 with Franseen and –1.60 with Fork-tip needle). No significant adverse events were registered. Conclusion Our meta-analysis speaks in favor of use of newer biopsy needles as a safe and effective tool in endoscopic ultrasound-guided tissue acquisition.

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Section: Resultsmentioning

confidence: 99%

Diagnostic yield of Franseen and Fork-Tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis

et al. 2019

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“…The number of passes was excluded from the model as this covariate did not provide a relevant contribution (pooled effect 0.14, 95% CI -0.46 to 0.75, p-value 0.638) and was missing for six studies [41,43,46,91,116,118]. After sensitivity analysis, two studies with a disproportionate influence were excluded ( Figure 11, supplementary fiIe) [47,77].…”

Section: Meta-regression Analysismentioning

confidence: 99%

“…After sensitivity analysis, two studies with a disproportionate influence were excluded (Fig. 9 s) [47,77].…”

Section: Meta-regression Analysismentioning

confidence: 99%

Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis

et al. 2020

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BACKGROUND EUS-guided tissue acquisition is extensively used, but the optimal sampling device is still a matter of debate. We performed a meta-analysis on studies comparing FNA to FNB needles, in addition to a mutual comparison of FNB needles. METHODS Online databases were searched for randomized controlled studies of at least 50 cases with a suspected solid pancreatic or non-pancreatic lesion that compared FNA to FNB ProCore, SharkCore, or Acquire needles. Outcome measures included diagnostic accuracy, adequacy, number of passes, presence of tissue cores, and adverse events. In addition, we performed a meta-regression analysis on the effect of FNB design on diagnostic accuracy. Quality was assessed using the QUADAS-2 tool. RESULTS 18 RCTs comparing FNA to FNB cases were included, all involving ProCore FNB needles. FNB provided a higher pooled diagnostic accuracy (87% vs 80%, p=0.02) and tissue core rate (77% vs 57%, p=0.01), and allowed a diagnosis within less passes (p=0.03). This was true for pancreatic and non-pancreatic lesions. 93 studies were included to compare the FNB devices. Pooled diagnostic accuracy was higher for SharkCore, Acquire and the ProCore forward facing bevel needles than for the ProCore reverse bevel needle. In this analysis, study quality was low and heterogeneity high (I2=80%). CONCLUSION FNB ProCore outperformed FNA when sampling pancreatic and non-pancreatic lesions. SharkCore, Acquire and ProCore forward facing bevel FNB needles seem to outperform the ProCore reverse bevel needle, but the low quality of evidence prevents us from making strong recommendations on the optimal FNB design.

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“…Recent studies, mainly those focusing on solid pancreatic masses only, achieved a diagnostic accuracy of 86%–96.5%. [ 6 14 15 21 25 31 32 ] The present study was not limited to solid pancreatic masses but included all patients referred for pancreatic EUS-FNB including cystic and benign lesions, where a precise diagnosis was needed for optimal patient management. As cystic lesions tend to offer less opportunity to obtain an adequate biopsy as there often only are limited solid areas such as thickened cyst wall or mural nodules suitable for biopsy compared to solid pancreatic masses, the higher proportion of cystic compared to only including solid lesions may, at least in part, explain the slightly lower accuracy in the present study (85.6%).…”

Section: Discussionmentioning

confidence: 99%

Accuracy and clinical outcomes of pancreatic EUS-guided fine-needle biopsy in a consecutive series of 852 specimens

et al. 2022

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Background and Objectives: Pancreatic EUS-guided fine needle biopsy (EUS-FNB) is increasingly used. Accuracy of EUS-FNB, particularly for benign diseases, utility of additional EUS-FNB if malignancy is suspected but initial diagnosis is inconclusive, and complication rate are not fully elucidated. We evaluated operating characteristics of EUS-FNB overall and for different diagnostic categories, value of additional EUS-FNB if malignancy is suspected but initial diagnosis is inconclusive, and frequency and type of complications. Methods: A retrospective tertiary single-center study including 852 consecutive pancreatic SharkCore EUS-FNBs from 723 patients between 2015 and 2020. EUS-FNB diagnoses were applied according to Papanicolaou Society's system and each category was further subcategorized. Results: Sufficient tissue cylinders for a histologic diagnosis were obtained in 93.4% (796/852). Accuracy was overall, for malignant, and benign entities 85.6% (confidence interval [CI]: 83.2%–87.9%), 88.3% (CI: 85.9%–90.4%), and 94% (CI: 92.2%–95.5%). Sensitivity and accuracy of EUS-FNB for autoimmune pancreatitis (AIP) ( n = 15) was 83.3% (CI: 58.6%–96.4%) and 99.2% (CI: 98.3%–99.7%). Of patients in whom malignancy was suspected but initial EUS-FNB diagnosis was inconclusive, 7.3% (53/723) underwent one or two additional EUS-FNBs, and in 54.7% (29/53) of these, a malignant diagnosis was established. The frequency of hospitalization following EUS-FNB was 4.7%, with 0.2% ( n = 2) incidents needing active intervention. Conclusions: We found a high accuracy of pancreatic EUS-FNB across all diagnostic categories including rare entities, such as AIP. In patients with a clinical suspicion of malignancy, additional EUS-FNB resulted in a conclusive diagnosis in more than half of cases. Complications necessitate hospitalization in almost 5%, but the majority are self-limiting.

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The diagnostic and cellularity yield of reverse bevel versus fork‐tip fine needle biopsy

Cited by 10 publications

References 18 publications

Diagnostic yield of Franseen and Fork-Tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis

Diagnostic yield of Franseen and Fork-Tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis

Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis

Accuracy and clinical outcomes of pancreatic EUS-guided fine-needle biopsy in a consecutive series of 852 specimens

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