Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: a meta-analysis

      Background and Aims

      There is limited evidence on the diagnostic performance of EUS-guided fine-needle biopsy (FNB) sampling in patients with subepithelial lesions. The aim of this meta-analysis was to compare EUS-guided FNB sampling performance with FNA in patients with GI subepithelial lesions.


      A computerized bibliographic search on the main databases was performed through May 2019. The primary endpoint was sample adequacy. Secondary outcomes were diagnostic accuracy, histologic core procurement rate, and mean number of needle passes. Summary estimates were expressed in terms of odds ratio (OR) and 95% confidence interval (CI).


      Ten studies (including 6 randomized trials) with 669 patients were included. Pooled rates of adequate samples for FNB sampling were 94.9% (range, 92.3%-97.5%) and for FNA 80.6% (range, 71.4%-89.7%; OR, 2.54; 95% CI, 1.29-5.01; P = .007). When rapid on-site evaluation was available, no significant difference between the 2 techniques was observed. Optimal histologic core procurement rate was 89.7% (range, 84.5%-94.9%) with FNB sampling and 65% (range, 55.5%-74.6%) with FNA (OR, 3.27; 95% CI, 2.03-5.27; P < .0001). Diagnostic accuracy was significantly superior in patients undergoing FNB sampling (OR, 4.10; 95% CI, 2.48-6.79; P < .0001) with the need of a lower number of passes (mean difference, –.75; 95% CI, –1.20 to –.30; P = .001). Sensitivity analysis confirmed these findings in all subgroups tested. Very few adverse events were observed and did not impact on patient outcomes.


      Our results speak clearly in favor of FNB sampling, which was found to outperform FNA in all diagnostic outcomes evaluated.

      Graphical abstract


      CI (confidence interval), FNB (fine-needle biopsy), OR (odds ratio), RCT (randomized controlled trial), ROSE (rapid on-site evaluation), SEL (subepithelial lesion)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dumonceau J.M.
        • Deprez P.H.
        • Jenssen C.
        • et al.
        Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline—updated January 2017.
        Endoscopy. 2017; 49: 695-714
        • Cantor M.J.
        • Davila R.E.
        • Faigel D.O.
        Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection.
        Gastrointest Endosc. 2006; 64: 29-34
        • Zhou X.D.
        • Lv N.H.
        • Chen H.X.
        • et al.
        Endoscopic management of gastrointestinal smooth muscle tumor.
        World J Gastroenterol. 2007; 13: 4897-4902
        • Sun S.
        • Ge N.
        • Wang C.
        • et al.
        Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography.
        Surg Endosc. 2007; 21: 574-578
        • Komanduri S.
        • Keefer L.
        • Jakate S.
        Diagnostic yield of a novel jumbo biopsy unroofing technique for tissue acquisition of gastric submucosal masses.
        Endoscopy. 2011; 43: 849-855
        • Ikehara H.
        • Li Z.
        • Watari J.
        • et al.
        Histological diagnosis of gastric submucosal tumors: a pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy.
        World J Gastrointest Endosc. 2015; 7: 1142-1149
        • Zhang X.C.
        • Li Q.L.
        • Yu Y.F.
        • et al.
        Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis.
        Surg Endosc. 2016; 30: 2431-2441
      1. Facciorusso A, Bajwa HS, Menon K, et al. Comparison between 22G aspiration and 22G biopsy needles for EUS-guided sampling of pancreatic lesions: a meta-analysis. Endosc Ultrasound. Epub 2019 Apr 26.

        • Lee J.H.
        • Choi K.D.
        • Kim M.Y.
        • et al.
        Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors ≥ 2 cm in diameter.
        Gastrointest Endosc. 2011; 74: 1010-1018
        • James T.W.
        • Baron T.H.
        A comprehensive review of endoscopic ultrasound core biopsy needles.
        Expert Rev Med Devices. 2018; 15: 127-135
        • Khan M.A.
        • Grimm I.S.
        • Ali B.
        • et al.
        A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment.
        Endosc Int Open. 2017; 5: E363-E375
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Int J Surg. 2010; 8: 336-341
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Wells G.A.
        • Shea B.
        • O’Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
        (Available at:)
      2. Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: Accessed on May 2, 2019.

        • Bang J.Y.
        • Kirtane S.
        • Krall K.
        • et al.
        In memoriam: fine-needle aspiration, birth: fine-needle biopsy: the changing trend in endoscopic ultrasound-guided tissue acquisition.
        Dig Endosc. 2019; 31: 197-202
        • Fujita A.
        • Ryozawa S.
        • Kobayashi M.
        • et al.
        Diagnostic ability of a 22G Franseen needle in endoscopic ultrasound-guided fine needle aspiration of subepithelial lesions.
        Mol Clin Oncol. 2018; 9: 527-531
        • El Chafic A.H.
        • Loren D.
        • Siddiqui A.
        • et al.
        Comparison of FNA and fine-needle biopsy for EUS-guided sampling of suspected GI stromal tumors.
        Gastrointest Endosc. 2017; 86: 510-515
        • Han J.P.
        • Lee T.H.
        • Hong S.J.
        • et al.
        EUS-guided FNA and FNB after on-site cytological evaluation in gastric subepithelial tumors.
        J Dig Dis. 2016; 17: 582-587
        • Hedenström P.
        • Marschall H.U.
        • Nilsson B.
        • et al.
        High clinical impact and diagnostic accuracy of EUS-guided biopsy sampling of subepithelial lesions: a prospective, comparative study.
        Surg Endosc. 2018; 32: 1304-1313
        • Inoue T.
        • Okumura F.
        • Sano H.
        • et al.
        Impact of endoscopic ultrasound-guided fine-needle biopsy on the diagnosis of subepithelial tumors: a propensity score-matching analysis.
        Dig Endosc. 2019; 31: 156-163
        • Iwai T.
        • Kida M.
        • Imaizumi H.
        • et al.
        Randomized crossover trial comparing EUS-guided fine-needle aspiration with EUS-guided fine-needle biopsy for gastric subepithelial tumors.
        Diagn Cytopathol. 2018; 46: 228-233
        • Kim G.H.
        • Cho Y.K.
        • Kim E.Y.
        • et al.
        Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling.
        Scand J Gastroenterol. 2014; 49: 347-354
        • Lee B.S.
        • Cho C.M.
        • Jung M.K.
        • et al.
        Comparison of histologic core portions acquired from a core biopsy needle and a conventional needle in solid mass lesions: a prospective randomized trial.
        Gut Liver. 2017; 11: 559-566
        • 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
        • Kandel P.
        • Wallace M.B.
        Recent advancement in EUS-guided fine needle sampling.
        J Gastroenterol. 2019; 54: 377-387
        • Facciorusso A.
        • Buccino R.V.
        • Muscatiello N.
        How to measure quality in endoscopic ultrasound.
        Ann Transl Med. 2018; 6: 266

      Linked Article

      • Diagnosis of subepithelial lesions: Should we rest on pieces?
        Gastrointestinal EndoscopyVol. 91Issue 1
        • Preview
          Often unexpectedly detected during a routine endoscopy, subepithelial lesions (SELs) are protruding lesions arising from the muscularis mucosa, submucosa, or muscularis propria covered with a normal mucosal surface. The differential diagnosis of such protruding lesions includes a broad range of entities, including stromal tumors, duplication cyst, lipoma, varix, pancreatic rest, and extrinsic compression from normal and abnormal structures.1 Most commonly found in the stomach, SELs, for a long time, seemed to be innocent and harmless findings.
        • Full-Text
        • PDF