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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.

      Methods

      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).

      Results

      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.

      Conclusions

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

      Graphical abstract

      Abbreviations:

      CI (confidence interval), FNB (fine-needle biopsy), OR (odds ratio), RCT (randomized controlled trial), ROSE (rapid on-site evaluation), SEL (subepithelial lesion)
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      Linked Article

      • Diagnosis of subepithelial lesions: Should we rest on pieces?
        Gastrointestinal EndoscopyVol. 91Issue 1
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          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.
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