Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

Donevan R. Westerveld; Sandeep A. Ponniah; Peter V. Draganov; Dennis Yang

doi:10.1055/a-1119-6543

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(05): E656-E667
DOI: 10.1055/a-1119-6543

Review

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

Authors

Donevan R. Westerveld

¹Department of Internal Medicine, University of Florida, Gainesville, Florida, United States
Sandeep A. Ponniah

¹Department of Internal Medicine, University of Florida, Gainesville, Florida, United States
Peter V. Draganov

²Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
Dennis Yang

²Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States

Abstract

Background and study aims Accurate diagnosis and risk stratification of pancreatic cysts (PCs) is challenging. The aim of this study was to perform a systematic review and meta-analysis to assess the feasibility, safety, and diagnostic yield of endoscopic ultrasound-guided through-the-needle biopsy (TTNB) versus fine-needle aspiration (FNA) in PCs.

Methods Comprehensive search of databases (PubMed, EMBASE, Cochrane, Web of Science) for relevant studies on TTNB of PCs (from inception to June 2019). The primary outcome was to compare the pooled diagnostic yield and concordance rate with surgical pathology of TTNB histology and FNA cytology of PCs. The secondary outcome was to estimate the safety profile of TTNB.
Results: Eight studies (426 patients) were included. The diagnostic yield was significantly higher with TTNB over FNA for a specific cyst type (OR: 9.4; 95 % CI: [5.7–15.4]; I² = 48) or a mucinous cyst (MC) (OR: 3.9; 95 % CI: [2.0–7.4], I² = 72 %). The concordance rate with surgical pathology was significantly higher with TTNB over FNA for a specific cyst type (OR: 13.5; 95 % CI: [3.5–52.3]; I² = 48), for a MC (OR: 8.9; 95 % [CI: 1.9–40.8]; I² = 29), and for MC histologic severity (OR: 10.4; 95 % CI: [2.9–36.9]; I² = 0). The pooled sensitivity and specificity of TTNB for MCs were 90.1 % (95 % CI: [78.4–97.6]; I² = 36.5 %) and 94 % (95 % CI: [81.5–99.7]; I² = 0), respectively. The pooled adverse event rate was 7.0 % (95 % CI: [2.3–14.1]; I² = 82.9).

Conclusions TTNB is safe, has a high sensitivity and specificity for MCs and may be superior to FNA cytology in risk-stratifying MCs and providing a specific cyst diagnosis.

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References

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