Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis

Benjamin D. Renelus; Daniel S. Jamorabo; Iman Boston; William M. Briggs; John M. Poneros

doi:10.5946/ce.2020.101

Articles

Page Path: HOME > Clin Endosc > Volume 54(2); 2021 > Article

Original Article Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis: Benjamin D. Renelus^1,, Daniel S. Jamorabo¹, Iman Boston², William M. Briggs³, John M. Poneros⁴; Clinical Endoscopy 2021;54(2):261-268.
DOI: https://doi.org/10.5946/ce.2020.101
Published online: August 31, 2020

¹Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA

²Department of Internal Medicine, Wright State University, Dayton, OH, USA

³Department of Epidemiology and Biostatistics, Weill Cornell Medical College, New York, NY, USA

⁴Division of Gastroenterology and Hepatology, New York Presbyterian, Columbia University Medical Center, New York, NY, USA

Correspondence: Benjamin D. Renelus Division of Gastroenterology and Hepatobiliary Disease, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th St. Brooklyn, NY 11215, USA Tel: +1-863-521-4574, Fax: +1-718-780-3478, E-mail: brenelus@gmail.com

• Received: April 17, 2020 • Revised: May 8, 2020 • Accepted: June 2, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

5,242 Views
191 Download
24 Web of Science
27 Crossref
22 Scopus

prev next

Full Article

Download PDF

Abstract
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
NOTES
REFERENCES

Abstract

Background/Aims
Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques.
Methods
We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed.
Results
Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64).
Conclusions
FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.
Keywords: Fine needle aspiration; Fine needle biopsy; Solid pancreatic lesions

INTRODUCTION

Pancreatic malignancy portends poor prognosis with a dismal 5-year survival of 8% [1]. Moreover, the disease burden of pancreatic cancer continues to rise, having the second highest incidence among gastrointestinal tumors in the U.S [2]. Prompt tissue diagnosis allows for early targeted treatment, potentially improving progression-free survival [3]. The advent of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has permitted minimally invasive tissue acquisition for tissue diagnosis. Unlike FNA needles, the reverse or opposing cutting bevel design of the FNB needle allows for the biopsy of core histopathologic tissue [4].

EUS-FNA and EUS-FNB provide accurate diagnoses of solid pancreatic lesions with a reported sensitivity of 85% and 87%, respectively [5,6]. Previous studies comparing the two needles have yielded conflicting results with no clear superiority [7-10]. There has been a recent increase in randomized controlled trials (RCTs) comparing the two techniques; however, there is a relative lack of updated meta-analyses examining clinical outcomes. This study aims to compare the clinical and technical outcomes between EUS-FNA and EUS-FNB when investigating solid pancreatic lesions.

MATERIALS AND METHODS

Search strategy and eligibility criteria

Two authors (BDR and DSJ) conducted an independent systematic electronic search of PubMed/Medline, Scopus, and Google Scholar databases for published articles comparing EUS-FNA and EUS-FNB between 01/01/2012 and 01/01/2019. The search strategy was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance using a predefined protocol [11]. With the assistance of an experienced health science librarian, the search terms used were EUS-FNA versus EUS-FNB AND pancreas OR pancreatic lesion. The aforementioned authors reviewed the study title and abstract for eligibility in the study. Disagreements were brought to the senior author (JMP) for final decision.

Studies were considered eligible if they met the following criteria: (1) RCT involving more than 30 live human participants; (2) published in the English language; and (3) provided data on the primary outcome, diagnostic accuracy. Studies were excluded if they were of a non-randomized design, involved animal or ex vivo studies, contained less than 30 participants, or lacked the outcome of interest.

Data extraction and quality assessment

Data abstraction was uniform for all studies and involved baseline characteristics and the outcomes of interests. To assess for clinical outcomes, records were collected of diagnostic accuracy and adverse event rate (AE). Technical success, histopathologic and cytopathologic accuracy, along with the number of passes required to obtain a diagnosis were obtained for technical outcomes. Study demographics and outcomes data can be viewed in Table 1. The Cochrane Collaboration’s tool was used to assess the quality and risk of bias of selected studies [12]. A Funnel plot was used to depict publication bias and Eggers regression test was used to quantitatively evaluate publication bias [13].

Outcomes analyzed

Our primary outcome was diagnostic accuracy, defined as a proportion of overall accurate cytopathologic and histopathologic tissue diagnoses established within the attempted number of passes. The secondary outcomes included AE; cytopathologic accuracy, defined as greater than 50% of target cells present; histopathologic accuracy, defined as presence of histopathologic architecture and tissue core; the mean number of needle passes to achieve adequate tissue diagnosis; and technical success, defined as the ability to obtain a tissue sample.

Statistical analysis

Forest plots containing fixed and random effect models were generated for each outcome of interest. The Mantel-Haenszel method was used to compare proportions between device outcomes, with p-value <0.05 chosen for the level of significance. For the calculation of pooled overall means of numerical values from individual studies, we used the inverse variance method. We also computed the differences in pooled means between outcomes of interest and assessed the p-values of this difference. Heterogeneity between studies was tested using the I² statistics of Higgins [14]. An I² >50% with a p-value <0.05 was considered statistically significant and prompted interpretation from the random effect model. We used the meta package version 4.9-1 for R, and version 3.5.2 for all analyses (R Foundation for Statistical Computing, Vienna, Austria). This study received approval from the institutional review board (IRB no. 618834-21). We received no funding for this study.

RESULTS

Studies included

We initially identified 257 records after duplicates were removed with our search strategy. After screening titles and abstracts, 236 articles were subsequently excluded. Six studies were also removed due to their retrospective or observational design, and 3 lacked the outcome of interest. One study was excluded due to the lack of a full manuscript. In total, 11 studies involving 1,365 patients were included for analysis (Fig. 1) [7,10,15-23].

The van Riet et al. [15] used a novel 20 G FNB needle while the Kamata et al. [17] used a 25 G core needle. The remaining studies used either 22 G FNB needles alone or multiple FNB needle sizes. Both the Kamata et al. and van Riet et al. used 25 G FNA needles, with the remaining studies using 22 G FNA or multiple needle sizes [15,17]. A total of 714 patients underwent FNA and 706 underwent FNB pancreatic tissue sampling.

Primary and secondary endpoints

The mean diagnostic accuracy for FNA and FNB was 81% and 87%, respectively (pooled relative risk [RR], 0.94; 95% confidence interval [CI], 0.90–0.98; p=0.005) (Fig. 2). The mean cytopathologic accuracy for FNA and FNB was 82% and 89%, respectively (pooled RR, 0.93; 95% CI, 0.87–1.00; p=0.04) (Fig. 3). There was a numerical increase in the mean histopathologic accuracy of FNB compared to FNA but this finding did not reach significance (81% and 74%, respectively, pooled RR, 0.90; 95% CI, 0.75–1.08; p=0.39) (Fig. 4). The mean technical success for FNA and FNB was 99% for both techniques (Fig. 5). FNB required almost one fewer needle passes to obtain adequate tissue compared to FNA (1.6 and 2.3, respectively, mean difference, 0.71; 95% CI, 0.38–1.04; p<0.0001) (Fig. 6).

Adverse events and quality assessment

There was no difference in the mean incident adverse events between FNB and FNA (2.3% and 1.8%, respectively, pooled RR, 1.13; 95% CI, 0.40–3.22; p=0.64) (Fig. 7). The Cochrane model showed a high-risk potential for bias in two studies, Aadam et al. in 2016 and Alatawi et al. in 2015 (Fig. 8) [18,19].

DISCUSSION

FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. To our knowledge, this is the most robust meta-analysis on this topic, limited to RCT. Our findings are similar to those of Li et al. [24] who also found that FNB provided superior diagnostic accuracy, specimen adequacy, and a reduced number of passes. However, cytopathologic differences were not reported in that study, although specimen adequacy was not defined and may be a surrogate for cytology. Furthermore, the authors included a prospective cohort study while we limited our data to RCTs. In their meta-analysis involving 8 RCT studies, Wang et al. [25] found a reduced number of passes required to obtain tissue using FNB needles. The authors, however, did not find any difference in diagnostic accuracy.

FNB needles have been designed to obtain core tissue permitting preserved histological characteristics. Core tissue sampling enables the ability to diagnose pancreatic adenocarcinoma much like FNA, but also provides the ability to differentiate among other solid pancreatic lesions [26]. Core tissue sampling can dramatically impact treatment by enabling molecular profiling which may be used for personalized medicine. Indeed, histopathologic specimens obtained from FNB yield an accurate pancreatic cancer diagnosis in over 90% of cases [5]. Although we found that FNB provided greater cytopathologic accuracy when compared to FNA, there was only an insignificant increase in histopathologic accuracy with core/FNB needles. We acknowledge that in clinical practice tissue biopsy can be obtained with EUS-FNA and both cytology and histology are utilized to improve diagnostic accuracy. Furthermore, there are reports of suboptimal diagnostic yield with FNB in extra-pancreatic organs. Mohan et al. cite increased liver tissue specimens with FNA needles when compared to FNB needles in their RCT [27]. The authors also found no difference in diagnostic accuracy, technical success, or the number of passes required to obtain adequate diagnostic tissue. Never-the-less, the majority of publications comparing the two devices either show improvement in tissue acquisition with FNB or no difference between the two needles.

EUS-FNA has long been shown to provide accurate yet safer diagnostic capabilities when investigating pancreatic pathology compared to computed tomography guided biopsy [28]. A concerns when using FNB is the potential increased risk of bleeding, as well as other complications. One way to address this concern is to provide fewer number of passes to obtain adequate tissue diagnosis. Our findings reveal a significant increase in the number of passes required to achieve adequate sampling with FNA compared to FNB. Increasing number of passes beyond 4 has not been shown to improve diagnostic yield in pancreatic cancer [29] and may increase the risk of complications [30]. Our findings showed a rare occurrence of AE, with no difference between FNA and FNB. Given the infrequence of AE and variations in reporting, we were unable to provide meaningful analysis regarding specific complications. Nevertheless, this study builds upon the safety of EUS-guided pancreatic tissue sampling irrespective of needle type.

There are currently three commercially available FNB needles [31]. Facciorusso et al. group found that newer FNB needles, which have three symmetric cutting edges along the tip of the needle, were favorable compared to other FNB needles [32]. Given the novelty, cost, and reliance upon operator experience, flexible FNB needles are often limited to robust referral centers.

There are notable limitations to our study. Firstly, we did not compare the various FNB needles due to the limited variations in comparative needle sizes in the studies analyzed. This is a growing area of interest as FNB needles are being utilized increasingly across medical centers. In addition, we were unable to analyze outcomes based upon the size and location of tumors due to inconsistent reporting. Moreover, potential bias was identified in our Cochrane model. Given this potential for confirmation bias, there is some concern that the results presented may be “too certain”. This certainty cannot however be quantified numerically and must be acknowledged when interpreting our results.

Shortcomings notwithstanding, conducting a meta-analysis on high-quality studies with limited heterogeneity is one of the strengths of our study. To the best of our knowledge, this is the most comprehensive meta-analysis restricted to RCT broaching this topic. The findings of this study shed light on the strengths of FNB needle. EUS-FNB provides a significantly higher diagnostic yield with no difference in AE and thus, should be readily considered by endosonographers. As this area of gastroenterology continues to progress, further investigation is required to understand the meaningful differences between core needle biopsies.

Conflicts of Interest: The authors have no potential conflicts of interest.

Funding

None.

Author Contributions

Conceptualization: Benjamin D. Renelus, Daniel S. Jamorabo

Data curation: BDR, DSJ, Iman Boston

Formal analysis: William M. Briggs

Investigation: BDR, DSJ

Methodology: BDR, DSJ, WMB

Software: WMB

Supervision: John M. Poneros

Visualization: WMB

Writing-original draft: BDR

Writing-review&editing: BDR, DSJ, IB, WMB, JMP

Fig. 1.

Study selection flow diagram.

Fig. 2.

Diagnostic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 3.

Cytopathologic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 4.

Histopathologic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 5.

Technical success. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 6.

Mean number of passes. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk; SD, standard deviation.

Fig. 7.

Adverse event rate. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 8.

Cochrane risk of bias.

Table 1.

Baseline Characteristics of Included Studies

Study	Study design	Participants, n	Men	Average age	FNA, n	FNB, n	FNA diagnostic accuracy (%)	FNB diagnostic accuracy (%)	FNA needle size (if only one size used)	FNB needle size (if only one size used)	Suction method (FNA/FNB)	FNA adverse events (%)	FNB adverse events (%)	Follow-up
van Riet et al. (2019) [15]	RCT	312		66	158	154	78	87	25 G	20 G		0.98	0.66	≥9 mo
Cheng et al. (2018) [10]	RCT	249	232	58	126	123	84.92	89.43	22 G	22 G	Stylet + 5 mL syringe	1.57	0.53	>11 mo
Tian et al. (2018) [16]	RCT	36	23	61	18	18	89	83	22 G	22 G	Stylet + 5 mL syringe	0	0	≥6 mo
Noh et al. (2018) [7]	RCT	60	35	62	30	30	95	93.3	22 G	22 G	Stylet + 10 mL syringe	0	0	≥6 mo
Kamata et al. (2016) [17]	RCT	214	112	67	108	106	75.9	79.2	25 G	25 G	Stylet			≥12 mo
Aadam et al. (2016) [18]	RCT	73		64	37	36	78.4	91.7			10 mL syringe/stylet	0	0
Alatawi et al. (2015) [19]	RCT	100	63	68	50	50	84	90	22 G	22 G	10 mL syringe			≥12 mo
Vanbiervliet et al. (2014) [20]	RCT	80	49	67	41	39	92.5	90	22 G	22 G	10 mL syringe for 20 sec	1.25	0	≥12 mo
Lee et al. (2014) [21]	RCT	116	73	63	58	58	94.8	98.3			10 mL syringe	1.7	5.2	≥6 mo
Hucl et al. (2013) [22]	RCT	69	37	52	60	64	75	86.8	22 G	22 G	10 mL syringe			≥6 mo
Bang et al. (2012) [23]	RCT	56	31	65	28	28	100	89.3	22 G	22 G	10 mL syringe 20 sec	3.6	3.6	6 mo

FNA, fine needle aspiration; FNB, fine needle biopsy; RCT, randomized controlled trial.

REFERENCES

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7–30.Article PubMed
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7–34.Article PubMed
3. Kleeff J, Korc M, Apte M, et al. Pancreatic cancer. Nat Rev Dis Primers 2016;2:16022.Article PubMed PDF
4. Nayar MK, Paranandi B, Dawwas MF, et al. Comparison of the diagnostic performance of 2 core biopsy needles for EUS-guided tissue acquisition from solid pancreatic lesions. Gastrointest Endosc 2017;85:1017–1024.Article PubMed
5. Ishikawa T, Mohamed R, Heitman SJ, et al. Diagnostic yield of small histological cores obtained with a new EUS-guided fine needle biopsy system. Surg Endosc 2017;31:5143–5149.Article PubMed PDF
6. Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012;75:319–331.Article PubMed
7. Noh DH, Choi K, Gu S, et al. Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial. Scand J Gastroenterol 2018;53:94–99.Article PubMed
8. Nagula S, Pourmand K, Aslanian H, et al. Comparison of endoscopic ultrasound-fine-needle aspiration and endoscopic ultrasound-fine-needle biopsy for solid lesions in a multicenter, randomized trial. Clin Gastroenterol Hepatol 2018;16:1307–1313.e1.Article PubMed
9. Hedenström P, Demir A, Khodakaram K, Nilsson O, Sadik R. EUS-guided reverse bevel fine-needle biopsy sampling and open tip fine-needle aspiration in solid pancreatic lesions - a prospective, comparative study. Scand J Gastroenterol 2018;53:231–237.Article PubMed
10. Cheng B, Zhang Y, Chen Q, et al. Analysis of fine-needle biopsy vs fine-needle aspiration in diagnosis of pancreatic and abdominal masses: a prospective, multicenter, randomized controlled trial. Clin Gastroenterol Hepatol 2018;16:1314–1321.Article PubMed
11. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009;151:W65–W94.Article PubMed
12. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.Article PubMed PMC
13. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–634.Article PubMed PMC
14. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–1558.Article PubMed
15. van Riet PA, Larghi A, Attili F, et al. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device. Gastrointest Endosc 2019;89:329–339.Article PubMed
16. Tian L, Tang AL, Zhang L, et al. Evaluation of 22G fine-needle aspiration (FNA) versus fine-needle biopsy (FNB) for endoscopic ultrasound-guided sampling of pancreatic lesions: a prospective comparison study. Surg Endosc 2018;32:3533–3539.Article PubMed PMC PDF
17. Kamata K, Kitano M, Yasukawa S, et al. Histologic diagnosis of pancreatic masses using 25-gauge endoscopic ultrasound needles with and without a core trap: a multicenter randomized trial. Endoscopy 2016;48:632–638.Article PubMed PDF
18. Aadam AA, Wani S, Amick A, et al. A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy. Endosc Int Open 2016;4:E497–E505.Article PubMed PMC PDF
19. Alatawi A, Beuvon F, Grabar S, et al. Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United European Gastroenterol J 2015;3:343–352.Article PubMed PMC
20. Vanbiervliet G, Napoléon B, Saint Paul MC, et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014;46:1063–1070.Article PubMed PDF
21. Lee YN, Moon JH, Kim HK, et al. Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study. Endoscopy 2014;46:1056–1062.Article PubMed PDF
22. Hucl T, Wee E, Anuradha S, et al. Feasibility and efficiency of a new 22G core needle: a prospective comparison study. Endoscopy 2013;45:792–798.Article PubMed PDF
23. Bang JY, Hebert-Magee S, Trevino J, Ramesh J, Varadarajulu S. Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions. Gastrointest Endosc 2012;76:321–327.Article PubMed PMC
24. Li H, Li W, Zhou QY, Fan B. Fine needle biopsy is superior to fine needle aspiration in endoscopic ultrasound guided sampling of pancreatic masses: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018;97:e0207.Article PubMed PMC
25. Wang J, Zhao S, Chen Y, Jia R, Zhang X. Endoscopic ultrasound guided fine needle aspiration versus endoscopic ultrasound guided fine needle biopsy in sampling pancreatic masses: a meta-analysis. Medicine (Baltimore) 2017;96:e7452.Article PubMed PMC
26. Conti CB, Cereatti F, Grassia R. Endoscopic ultrasound-guided sampling of solid pancreatic masses: the fine needle aspiration or fine needle biopsy dilemma. Is the best needle yet to come? World J Gastrointest Endosc 2019;11:454–471.Article PubMed PMC
27. Mohan BP, Shakhatreh M, Garg R, Ponnada S, Adler DG. Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis. Gastrointest Endosc 2019;89:238–246.e3.Article PubMed
28. Okasha HH, Naga MI, Esmat S, et al. Endoscopic ultrasound-guided fine needle aspiration versus percutaneous ultrasound-guided fine needle aspiration in diagnosis of focal pancreatic masses. Endosc Ultrasound 2013;2:190–193.Article PubMed PMC
29. Mohamadnejad M, Mullady D, Early DS, et al. Increasing number of passes beyond 4 does not increase sensitivity of detection of pancreatic malignancy by endoscopic ultrasound-guided fine-needle aspiration. Clin Gastroenterol Hepatol 2017;15:1071–1078.e2.Article PubMed
30. Erickson RA, Sayage-Rabie L, Beissner RS. Factors predicting the number of EUS-guided fine-needle passes for diagnosis of pancreatic malignancies. Gastrointest Endosc 2000;51:184–190.Article PubMed
31. Abdelfatah MM, Grimm IS, Gangarosa LM, Baron TH. Cohort study comparing the diagnostic yields of 2 different EUS fine-needle biopsy needles. Gastrointest Endosc 2018;87:495–500.Article PubMed
32. Facciorusso A, Del Prete V, Buccino VR, Purohit P, Setia P, Muscatiello N. Diagnostic yield of Franseen and fork-tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis. Endosc Int Open 2019;7:E1221–E1230.Article PubMed PMC PDF

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

The yield of cytology and histology obtained by endoscopic ultrasound‐guided fine needle aspiration and biopsy needles in the diagnosis of pancreatic adenocarcinoma
Wisam Sbeit, Nidaa Abu Hanna, Livoff Alejandro, Tawfik Khoury
Cytopathology.2024; 35(1): 92. CrossRef
Diagnosis of lung squamous cell carcinoma using EUS-guided fine-needle biopsy sampling of a lung lesion
Jenson Phung, Mohamed Abdallah, Mohammad Bilal
iGIE.2024; 3(1): 32. CrossRef
EUS-guided tissue acquisition in patients with solid pseudopapillary neoplasms of the pancreas
José M. Jiménez-Gutiérrez, José G. de la Mora-Levy, Juan O. Alonso-Lárraga, Angélica I. Hernández-Guerrero, Betsabé A. Soriano-Herrera, Lidia F. Villegas-González, Luis F. Uscanga-Domínguez, Stephanie López-Romero, Félix I. Téllez-Ávila
Postgraduate Medicine.2024; 136(1): 78. CrossRef
Endoscopic Ultrasound-Guided Fine-Needle Biopsy Versus Aspiration for Tissue Sampling Adequacy for Molecular Testing in Pancreatic Ductal Adenocarcinoma
Wael T. Mohamed, Vinay Jahagirdar, Fouad Jaber, Mohamed K. Ahmed, Ifrah Fatima, Thomas Bierman, Zhuxuan Fu, Philip G. Jones, Amira F. Hassan, Erin Faber, Wendell K. Clarkston, Hassan Ghoz, Ossama W. Tawfik, Sreeni Jonnalagadda
Cancers.2024; 16(4): 761. CrossRef
Endoscopic ultrasound‐guided biopsy using a three‐prong asymmetry tip needle for pancreatic tumors and peridigestive tract lesions: Retrospective single‐center study
Kento Shionoya, Ryosuke Tonozuka, Shuntaro Mukai, Takayoshi Tsuchiya, Reina Tanaka, Kenjiro Yamamoto, Kazumasa Nagai, Yukitoshi Mastunami, Hiroyuki Kojima, Takao Itoi
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 294. CrossRef
The factors that influence the diagnostic accuracy and sample adequacy of EUS-guided tissue acquisition for the diagnosis of solid pancreatic lesions
Liqi Sun, Yuqiong Li, Qiuyue Song, Lisi Peng, Ying Xing, Haojie Huang, Zhendong Jin
Endoscopic Ultrasound.2024;[Epub] CrossRef
Experience of Endoscopic Ultrasound Guided Fine Needle Aspiration and Fine Needle Biopsy: Data from Tertiary Care Hospital in Pakistan
Hafiz Irfan Mushtaq, Fariha Shams, Shafqat Rasool, Ghias Ul Hassan, Sadia Jabbar, Farwa Javed, Sidra Rasheed, Akif Dlishad, Ghias Un Nabi Tayyab
Pakistan Journal of Health Sciences.2024; : 31. CrossRef
Impact of macroscopic on-site evaluation (MOSE) on accuracy of endoscopic ultrasound-guided fine-needle aspiration/biopsy of solid lesions
Hussein Okasha, Ahmed Ebrahim, Ihab Samih, Mohammed Sayed
International Journal of Gastrointestinal Intervention.2024; 13(3): 98. CrossRef
The Role of CT-guided Core Needle Biopsy in Pancreatic Tumors: An Initial Evaluation in Modern Oncology
Eduardo P. Eyheremendy, Cristian A. Angeramo, Patricio Méndez
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024;[Epub] CrossRef
ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures
B. Joseph Elmunzer, Jennifer L. Maranki, Victoria Gómez, Anna Tavakkoli, Bryan G. Sauer, Berkeley N. Limketkai, Emily A. Brennan, Elaine M. Attridge, Tara J. Brigham, Andrew Y. Wang
American Journal of Gastroenterology.2023; 118(3): 405. CrossRef
Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor
Sakue Masuda, Kazuya Koizumi, Kento Shionoya, Ryuhei Jinushi, Makomo Makazu, Takashi Nishino, Karen Kimura, Chihiro Sumida, Jun Kubota, Chikamasa Ichita, Akiko Sasaki, Masahiro Kobayashi, Makoto Kako, Uojima Haruki
World Journal of Gastroenterology.2023; 29(12): 1863. CrossRef
Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ
Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito
Clinical Endoscopy.2023; 56(3): 353. CrossRef
Current status and issues in genomic analysis using EUS-FNA/FNB specimens in hepatobiliary–pancreatic cancers
Yoshinori Ozono, Hiroshi Kawakami, Naomi Uchiyama, Hiroshi Hatada, Souichiro Ogawa
Journal of Gastroenterology.2023; 58(11): 1081. CrossRef
Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef
Diagnostic value of endoscopic ultrasound in groove pancreatitis
Yu Mo She, Nan Ge
Annals of Medicine.2023;[Epub] CrossRef
The Role of Endoscopic Ultrasonography in the Diagnosis and Staging of Pancreatic Cancer
Ali Zakaria, Bayan Al-Share, Jason B. Klapman, Aamir Dam
Cancers.2022; 14(6): 1373. CrossRef
A Meta-Analysis Comparing Endoscopic Ultrasound-guided Fine-needle Aspiration With Endoscopic Ultrasound-guided Fine-needle Biopsy
Zhiwang Li, Wei Liu, Xiaoda Xu, Peiyu Li
Journal of Clinical Gastroenterology.2022; 56(8): 668. CrossRef
Endoscopic ultrasound‐guided tissue acquisition for pancreatic ductal adenocarcinoma in the era of precision medicine
Reiko Ashida, Masayuki Kitano
Digestive Endoscopy.2022; 34(7): 1329. CrossRef
Diagnostic performance of endoscopic ultrasound-guided tissue acquisition by EUS-FNA versus EUS-FNB for solid pancreatic mass without ROSE: a retrospective study
Thanawin Wong, Tanawat Pattarapuntakul, Nisa Netinatsunton, Bancha Ovartlarnporn, Jaksin Sottisuporn, Naichaya Chamroonkul, Pimsiri Sripongpun, Sawangpong Jandee, Apichat Kaewdech, Siriboon Attasaranya, Teerha Piratvisuth
World Journal of Surgical Oncology.2022;[Epub] CrossRef
Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
Woo Hyun Paik
International Journal of Gastrointestinal Intervention.2022; 11(3): 96. CrossRef
Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis
Yen-Chih Lin, Hsu-Heng Yen, Siou-Ping Huang, Kai-Lun Shih, Yang-Yuan Chen
Diagnostics.2022; 12(9): 2123. CrossRef
Endoscopic Ultrasound Guided Fine Needle Aspiration versus Endoscopic Ultrasound Guided Fine Needle Biopsy for Pancreatic Cancer Diagnosis: A Systematic Review and Meta-Analysis
Galab M. Hassan, Louise Laporte, Sarto C. Paquin, Charles Menard, Anand V. Sahai, Benoît Mâsse, Helen Trottier
Diagnostics.2022; 12(12): 2951. CrossRef
Endoscopic Ultrasound Quality Metrics in Clinical Practice
Lawrence Ku, Linda A. Hou, Viktor E. Eysselein, Sofiya Reicher
Diagnostics.2021; 11(2): 242. CrossRef
Personalized Approach to the Role of Endoscopic Ultrasound in the Diagnosis and Management of Pancreaticobiliary Malignancies
Michael Makar, Eric Zhao, Amy Tyberg
Journal of Personalized Medicine.2021; 11(3): 180. CrossRef
Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Two-Center Experience
Antonio Facciorusso, Daryl Ramai, Maria Cristina Conti Bellocchi, Laura Bernardoni, Erminia Manfrin, Nicola Muscatiello, Stefano Francesco Crinò
Cancers.2021; 13(12): 3062. CrossRef
Endoscopic ultrasound‐guided fine‐needle biopsy histology with a 22‐gauge Franseen needle and fine‐needle aspiration liquid‐based cytology with a conventional 25‐gauge needle provide comparable diagnostic accuracy in solid pancreatic lesions
Yoichi Tomita, Yuichi Torisu, Masafumi Chiba, Yuji Kinoshita, Takafumi Akasu, Nana Shimamoto, Takahiro Abe, Keisuke Kanazawa, Kazuki Takakura, Shintaro Tsukinaga, Masanori Nakano, Hirobumi Toyoizumi, Masayuki Kato, Masayuki Saruta
JGH Open.2021; 5(9): 1092. CrossRef
Comparison of Endoscopic Ultrasound-Guided Tissue Acquisition Using a 20-Gauge Menghini Needle with a Lateral Forward Bevel and a 22-Gauge Franseen Needle: A Single-Center Large Cohort Study
Takafumi Mie, Takashi Sasaki, Ryo Kanata, Takaaki Furukawa, Tsuyoshi Takeda, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clinical Endoscopy.2021; 54(5): 730. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis

Clin Endosc. 2021;54(2):261-268. Published online August 31, 2020

DOI: https://doi.org/10.5946/ce.2020.101

XML Download

Figure

Fig. 1. Study selection flow diagram.

Fig. 2. Diagnostic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 3. Cytopathologic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 4. Histopathologic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 5. Technical success. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 6. Mean number of passes. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk; SD, standard deviation.

Fig. 7. Adverse event rate. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

Fig. 8. Cochrane risk of bias.

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Study	Study design	Participants, n	Men	Average age	FNA, n	FNB, n	FNA diagnostic accuracy (%)	FNB diagnostic accuracy (%)	FNA needle size (if only one size used)	FNB needle size (if only one size used)	Suction method (FNA/FNB)	FNA adverse events (%)	FNB adverse events (%)	Follow-up
van Riet et al. (2019) [15]	RCT	312		66	158	154	78	87	25 G	20 G		0.98	0.66	≥9 mo
Cheng et al. (2018) [10]	RCT	249	232	58	126	123	84.92	89.43	22 G	22 G	Stylet + 5 mL syringe	1.57	0.53	>11 mo
Tian et al. (2018) [16]	RCT	36	23	61	18	18	89	83	22 G	22 G	Stylet + 5 mL syringe	0	0	≥6 mo
Noh et al. (2018) [7]	RCT	60	35	62	30	30	95	93.3	22 G	22 G	Stylet + 10 mL syringe	0	0	≥6 mo
Kamata et al. (2016) [17]	RCT	214	112	67	108	106	75.9	79.2	25 G	25 G	Stylet			≥12 mo
Aadam et al. (2016) [18]	RCT	73		64	37	36	78.4	91.7			10 mL syringe/stylet	0	0
Alatawi et al. (2015) [19]	RCT	100	63	68	50	50	84	90	22 G	22 G	10 mL syringe			≥12 mo
Vanbiervliet et al. (2014) [20]	RCT	80	49	67	41	39	92.5	90	22 G	22 G	10 mL syringe for 20 sec	1.25	0	≥12 mo
Lee et al. (2014) [21]	RCT	116	73	63	58	58	94.8	98.3			10 mL syringe	1.7	5.2	≥6 mo
Hucl et al. (2013) [22]	RCT	69	37	52	60	64	75	86.8	22 G	22 G	10 mL syringe			≥6 mo
Bang et al. (2012) [23]	RCT	56	31	65	28	28	100	89.3	22 G	22 G	10 mL syringe 20 sec	3.6	3.6	6 mo

Table 1. Baseline Characteristics of Included Studies

FNA, fine needle aspiration; FNB, fine needle biopsy; RCT, randomized controlled trial.