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. 2017 Oct;5(6):846-853.
doi: 10.1177/2050640616680972. Epub 2016 Nov 17.

Endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions with 22 versus 25 Gauge needles: A meta-analysis

Antonio Facciorusso  1 , Elisa Stasi  2 , Marianna Di Maso  1 , Gaetano Serviddio  3 , Mohammed Salah Ali Hussein  1   4 , Nicola Muscatiello  1
Affiliations

Endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions with 22 versus 25 Gauge needles: A meta-analysis

Antonio Facciorusso et al. United European Gastroenterol J. 2017 Oct.

Abstract

Background: Robust data in favour of a clear superiority of 22 versus 25 Gauge needles for endoscopic ultrasound-guided fine needle aspiration are still lacking.

Objective: We aimed to compare the diagnostic sensitivity, specificity and safety of these two needles for endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions.

Methods: A computerized bibliographic search was restricted to randomized controlled trials only. Pooled effects were calculated using a random-effects model and expressed in terms of risk ratio and 95% confidence interval.

Results: We analysed seven trials with 689 patients and 732 lesions (295 sampled with 22 Gauge needle, 309 with 25 Gauge needle, and 128 with both needles). A non-significant superiority of 25 Gauge in terms of pooled sensitivity (risk ratio: 0.93, 0.91-0.95 versus 0.89, 0.85-0.94 of 22 Gauge needle; p = 0.13) and no difference in terms of specificity (1.00, 0.98-1.00 in both groups; p = 0.85) were observed. Sample adequacy was similar between the two devices (risk ratio: 1.03, 0.99-1.06; p = 0.15). Very few adverse events were observed and did not impact on patient outcomes.

Conclusion: Our meta-analysis reveals non-superiority of 25 Gauge over 22 Gauge; hence no definitive recommendations over the use of one particular device can be made.

Keywords: EUS; FNA; pancreas; sensitivity; specificity.

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Figures

Figure 1.
Figure 1.
Flow chart of included studies.
Figure 2.
Figure 2.
Sensitivity of 22 G (a) and 25 G (b) needles in individual study and pooled estimate. Pooled sensitivity of 22 G needles was 0.89 (95% CI: 0.85–0.94) while sensitivity of 25 G needles was 0.93 (0.91–0.95). The bivariate generalized random-effect model showed a non-significant superiority of 25 G (p = 0.13). No evidence of heterogeneity was found (I2 = 12%).
Figure 3.
Figure 3.
Specificity of 22 G (a) and 25 G (b) needles in individual studies and pooled estimate. Pooled specificity of 22 G needle was 1.00 (95% CI: 0.98–1.00) in both groups. No evidence of heterogeneity was found (I2 = 0%).
Figure 4.
Figure 4.
Weighted summary receiver operating characteristics (ROC) curve for studies involving the 22 G needle (a) and the 25 G needle (b). The area under the ROC curve was 0.99 for 22 G and 0.98 for 25 G needle.
Figure 5.
Figure 5.
Forest plot of risk ratios for sample adequacy with 22 G and 25 G needles. Risk ratio for sample adequacy was very near to 1 with only a slight increase in favour of 25 G needles (1.03, 0.99–1.06) which did not reach the significance threshold (p = 0.15). No evidence of heterogeneity was observed (I2 = 0%, Chi2 = 4.92, df = 6; p = 0.55).
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