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Comparative Diagnostic Performance of Different Techniques for Endoscopic Ultrasound-Guided Fine-Needle Biopsy of Solid Pancreatic Masses: A Network Meta-analysis

Published:January 16, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.024
Comparative Diagnostic Performance of Different Techniques for Endoscopic Ultrasound-Guided Fine-Needle Biopsy of Solid Pancreatic Masses: A Network Meta-analysis
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      ABSTRACT

      Background and Aims

      There is limited evidence on the comparative diagnostic performance of tissue sampling techniques for endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB) of pancreatic masses. We performed a systematic review with network meta-analysis to compare these techniques.

      Methods

      Rates of sample adequacy, blood contamination, and tissue integrity using FNB needles were evaluated.
      Direct and indirect comparisons were performed among slow-pull technique, “dry suction”, “modified wet suction”, or “no suction”. Results were expressed as risk ratio (RR) and 95% confidence interval (CI).

      Results

      Overall, 9 RCTs (756 patients) were identified. On network meta-analysis, “no suction” technique was significantly inferior to the other techniques (RR 0.85, 95% CI 0.78-0.92 vs slow pull; RR 0.85, 0.78-0.92 vs “dry suction”; RR 0.83, 0.76-0.90 vs “modified wet suction”) in terms of sample adequacy. Consequently, “modified wet suction” resulted as the best technique (SUCRA 0.90), with “no suction” showing poorer performance in terms of sample adequacy (SUCRA score 0.14). “Dry suction” was associated with significantly higher rates of blood contamination as compared to slow pull (RR 1.44, 1.15-1.80), whereas “no suction” led to less blood contamination of samples in comparison to other techniques (RR 0.71, 0.52-0.97 vs slow pull; RR 0.49, 0.36-0.66 vs “dry suction”; RR 0.57, 0.40-0.81 vs “modified wet suction”). “Modified wet suction” significantly outperformed “dry suction” in terms of tissue integrity of the sample (RR 1.36, 1.06-1.75).

      Conclusion

      “Modified wet suction” seems to provide high rates of integrity and adequate samples, although with high blood contamination. “No suction” technique performs significantly worse than other sampling strategies.

      Key words

      Abbreviations:

      FNB (Fine needle biopsy), FNA (Fine needle aspiration), EUS (endoscopic ultrasound), RR (risk ratio), CI (confidence interval), TA (tissue acquisition), RCT (randomized controlled trials), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), GRADE (Grading of Recommendations Assessment, Development and Evaluation)
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      Article info

      Publication history

      Accepted: January 7, 2023
      Received in revised form: November 22, 2022
      Received: October 13, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Specific author contributions: Antonio Facciorusso designed the study and performed the statistical analysis; Deepak Madhu and Daryl Ramai retrieved the data; Stefano Francesco Crinò, Daryl Ramai, Alessandro Fugazza, Silvia Carrara, Marco Spadaccini, Benedetto Mangiavillano, Paraskevas Gkolfakis, Babu P Mohan, Cesare Hassan, Alessandro Repici reviewed and revised the manuscript. Manuscript has been read and approved by all the authors.

      Conflict of interest: Alessandro Fugazza: Consultant for Boston Scientifics; Stefano Francesco Crinò: Consultant for Steris Endsocopy; Silvia Carrara: Consultant for Olympus; Benedetto Mangiavillano: Consultant for Taewoong Medical; Cesare Hassan: Consultant for MicroTech and Boston Scientifics; Alessandro Repici: Consultant for Boston Scientific and Medtronic, grant support from Fujifilm. All other authors disclosed no financial relationships.

      Funding: No funding to declare regarding the current work

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.01.024

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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