Comparison between 22G aspiration and 22G biopsy needles for EUS-guided sampling of pancreatic lesions: A meta-analysis

Abstract

Background and objective: Robust data in favor of clear superiority of 22G fine-needle biopsy (FNB) over 22G FNA for an echoendoscopic-guided sampling of pancreatic masses are lacking. The objective of this study is to compare the diagnostic outcomes and sample adequacy of these two needles.

Materials and methods: Computerized bibliographic search on the main databases was performed and restricted to only randomized controlled trials. Summary estimates were expressed regarding risk ratio (RR) and 95% confidence interval.

Results: A total of 11 trials with 833 patients were analyzed. The two needles resulted comparable in terms of diagnostic accuracy (RR 1.02, 0.97-1.08; P = 0.46), sample adequacy (RR 1.01, 0.96-1.06; P = 0.61), and histological core procurement (RR 1.01, 0.89-1.15; P = 0.86). Pooled sensitivity in the diagnosis of pancreatic cancer was 93.1% (87.9%-98.4%) and 90.4% (86.3%-94.5%) with biopsy and aspirate, respectively, whereas specificity for detecting pancreatic cancer was 100% with both needles. Analysis of the number of needle passes showed a nonsignificantly positive trend in favor of FNB (mean difference: -0.32, -0.66-0.02; P = 0.07).

Conclusion: Our meta-analysis stands for a nonsuperiority of 22G FNB over 22G FNA; hence, no definitive recommendations on the use of a particular device can be made.

Keywords: Accuracy; EUS; FNA; fine-needle biopsy; pancreas; sensitivity.

Figure 1

Flow chart of included studies

Figure 2

Meta-analysis comparing the diagnostic accuracy of 22G fine-needle biopsy and 22G FNA. The two needles resulted comparable regarding diagnostic accuracy (risk ratio 1.02, 95% confidence interval 0.97–xs1.08; P = 0.46) with moderate evidence of heterogeneity (I² = 32%)

Figure 3

Meta-analysis comparing sample adequacy of 22G fine-needle biopsy and 22G FNA. Risk ratio for sample adequacy was very close to 1 with only a slight increase in favor of 22G FNB (P = 0.61). Moderate evidence of heterogeneity was observed (I² = 37%)

Figure 4

Meta-analysis comparing mean number of needle passes of 22G fine-needle biopsy and 22G FNA. Analysis of number of needle passes needed to obtain adequate sample showed a nonsignificantly positive trend in favor of FNB (mean difference: −0.32, −0.66–xs0.02; P = 0.07) with high evidence of heterogeneity (I² = 89%)