Advertisement

Diagnostic yield of EUS-guided through-the-needle biopsy in pancreatic cysts: a meta-analysis

Published:January 31, 2020DOI:https://doi.org/10.1016/j.gie.2020.01.038

      Background and Aims

      There is currently limited evidence supporting the use of EUS-guided through-the-needle biopsy for sampling pancreatic cystic lesions. The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of through-the-needle biopsy for sampling of pancreatic cysts.

      Methods

      A bibliographic search on the main databases was performed in September 2019. Pooled effects were calculated using a random-effects model by means of the DerSimonian and Laird test. The primary outcome was sample adequacy. Additional endpoints were diagnostic accuracy, optimal histologic core procurement, mean number of needle passes, pooled specificity, and sensitivity. Adverse event rates were also analyzed.

      Results

      Eleven studies enrolling 490 patients were included. Eight articles compared through-the-needle biopsy with cytology/cystic fluid analysis. Most patients were female, and the body/tail was the most frequent location of cystic lesions. Sample adequacy with through-the-needle biopsy was 85.3% (78.2%-92.5%), and subanalysis performed according to cyst morphology, size, and location confirmed the result. Through-the-needle biopsy clearly outperformed FNA both in terms of sample adequacy (odds ratio, 4.83; 95% confidence interval, 1.63-14.31; P =.004) and diagnostic accuracy (odds ratio, 3.44; 95% confidence interval, 1.32-8.96; P =.01). The pooled diagnostic accuracy rate, sensitivity, and specificity of through-the-needle biopsy were 78.8%, 82.2%, and 96.8%, respectively. A mean of 3.121 (2.98-3.25) passes through the cyst was needed to obtain adequate histologic samples. The incidence rates of mild bleeding and pancreatitis were 4% and 2%, respectively.

      Conclusion

      Our meta-analysis speaks in favor of the use of through-the-needle biopsy as a safe and effective tool in EUS-guided tissue acquisition of pancreatic cysts.

      Abbreviations:

      CI (confidence interval), FNB (fine-needle biopsy), OR (odds ratio), PCL (pancreatic cystic lesion), TTNB (through-the-needle tissue biopsy)
      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:

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

      References

        • Farrell J.J.
        • Fernández-del Castillo C.
        Pancreatic cystic neoplasms: management and unanswered questions.
        Gastroenterology. 2013; 144: 1303-1315
        • F Stark A
        • Donahue T.R.
        • Reber H.A.
        • et al.
        Pancreatic cyst disease: a review.
        JAMA. 2016; 315: 1882-1893
        • Fernández-del Castillo C.
        • Adsay N.V.
        Intraductal papillary mucinous neoplasms of the pancreas.
        Gastroenterology. 2010; 139 (e1-e2): 708-713
        • van Riet P.A.
        • Cahen D.L.
        • Poley J.W.
        • et al.
        Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey.
        Endosc Int Open. 2016; 4: E360-E370
        • Thornton G.D.
        • McPhail M.J.
        • Nayagam S.
        • et al.
        Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis.
        Pancreatology. 2013; 13: 48-57
        • van der Waaij L.A.
        • van Dullemen H.M.
        • Porte R.J.
        Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis.
        Gastrointest Endosc. 2005; 62: 383-389
        • Brugge W.R.
        • Lewandrowski K.
        • Lee-Lewandrowski E.
        • et al.
        Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.
        Gastroenterology. 2004; 126: 1330-1336
        • de Jong K.
        • Poley J.W.
        • van Hooft J.E.
        • et al.
        Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study.
        Endoscopy. 2011; 43: 585-590
        • Singhi A.D.
        • McGrath K.
        • Brand R.E.
        • et al.
        Pre-operative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia.
        Gut. 2018; 67: 2131-2141
        • Anand K.
        • Kahaleh M.
        • Tyberg A.
        Use of needle-based confocal laser endomicroscopy in the diagnosis and management of pancreatic cyst lesions.
        Endosc Ultrasound. 2018; 7: 306-309
        • 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
        • 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
        • 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:)
        • Basar O.
        • Yuksel O.
        • Yang D.J.
        • et al.
        Feasibility and safety of microforceps biopsy in the diagnosis of pancreatic cysts.
        Gastrointest Endosc. 2018; 88: 79-86
        • Cheesman A.R.
        • Zhu H.
        • Kumta N.A.
        • et al.
        EUS-guided microforceps biopsy and needle-based confocal laser endomicroscopy significantly improve the diagnostic yield and have major impact on clinical management of pancreatic cystic lesions [abstract].
        Gastrointest Endosc. 2019; 89: AB144
        • Crinò S.F.
        • Bernardoni L.
        • Brozzi L.
        • et al.
        Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions.
        Gastrointest Endosc. 2019; 90: 933-943
        • Kovacevic B.
        • Karstensen J.G.
        • Havre R.F.
        • et al.
        Initial experience with EUS-guided microbiopsy forceps in diagnosing pancreatic cystic lesions: A multicenter feasibility study (with video).
        Endosc Ultrasound. 2018; 7: 383-388
        • Mittal C.
        • Obuch J.C.
        • Hammad H.
        • et al.
        Technical feasibility, diagnostic yield, and safety of microforceps biopsies during EUS evaluation of pancreatic cystic lesions (with video).
        Gastrointest Endosc. 2018; 87: 1263-1269
        • Robles-Medranda C.
        • Olmos J.I.
        • et al.
        EUS-through-the-needle technologies in the diagnosis and malignancy detection of pancreatic cysts: a comparative study between different technologies [abstract].
        Gastrointest Endosc. 2019; 89: AB608-A609
        • Samarasena J.
        • Yu A.
        • Lee D.
        • et al.
        EUS-guided through-the-needle biopsy for pancreatic cystic lesions.
        VideoGIE. 2019; 4: 436-439
        • Vestrup Rift C.
        • Melchior L.C.
        • Kovacevic B.
        • et al.
        Next-generation sequencing of endoscopic ultrasound guided microbiopsies from pancreatic cystic neoplasms.
        Histopathology. 2019; 75: 767-771
        • Zhang M.L.
        • Arpin R.N.
        • Brugge W.R.
        • et al.
        Moray micro forceps biopsy improves the diagnosis of specific pancreatic cysts.
        Cancer Cytopathol. 2018; 126: 414-420
        • Yang D.
        • Trindade A.J.
        • Yachimski P.
        • et al.
        Histologic analysis of endoscopic ultrasound-guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts.
        Clin Gastroenterol Hepatol. 2019; 17: 1587-1596
        • Wilen J.
        • Visrodia K.
        • Lan G.
        • et al.
        The feasibility and value of cyst wall biopsy using micro forceps in the diagnosis of pancreatic cysts [abstract].
        Gastrointest Endosc. 2019; 89: AB605
        • Barresi L.
        • Tarantino I.
        • Traina M.
        • et al.
        Endoscopic ultrasound-guided fine needle aspiration and biopsy using a 22-gauge needle with side fenestration in pancreatic cystic lesions.
        Dig Liver Dis. 2014; 46: 45-50
        • Barresi L.
        • Tacelli M.
        • Ligresti D.
        • et al.
        Tissue acquisition in pancreatic cystic lesions.
        Dig Liver Dis. 2019; 51: 286-292
        • Crinò S.F.
        • Bernardoni L.
        • Gabbrielli A.
        • et al.
        Beyond pancreatic cyst epithelium: evidence of ovarian-like stroma in EUS-guided through the-needle micro-forceps biopsy specimens.
        Am J Gastroenterol. 2018; 113: 1059-1060
        • Barresi L.
        • Tacelli M.
        • Chiarello G.
        • et al.
        Mucinous cystic neoplasia with denuded epithelium: EUS through-the-needle biopsy diagnosis.
        Gastrointest Endosc. 2018; 88: 771-774
        • Facciorusso A.
        • Wani S.
        • Triantafyllou K.
        • et al.
        Comparative accuracy of needle sizes and designs for EUS tissue sampling of solid pancreatic masses: a network meta-analysis.
        Gastrointest Endosc. 2019; 90: 893-903.e7
        • Facciorusso A.
        • Bajwa H.S.
        • 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;
        • Facciorusso A.
        • Stasi E.
        • Di Maso M.
        • et al.
        Endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions with 22 versus 25 gauge needles: a meta-analysis.
        United European Gastroenterol J. 2017; 5: 846-853
        • Gómez V.
        • Majumder S.
        • Smyrk T.C.
        • et al.
        Pancreatic cyst epithelial denudation: a natural phenomenon in the absence of treatment.
        Gastrointest Endosc. 2016; 84: 788-793

      Linked Article