Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis

Abstract

Background and study aims Given variable diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for pancreatic cystic lesions (PCLs), a through-the-needle (TTN) microforceps biopsy device passed through a 19-gauge FNA needle has been devised to improve tissue sampling. This was a systematic review and meta-analysis to evaluate the feasibility, diagnostic yield, and safety of EUS-guided TTN microforceps biopsy for diagnosis of PCLs. Methods Individualized searches were developed in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, diagnostic yield, accuracy, and procedure-associated adverse events (AEs) as well as comparison to conventional FNA. Results Eleven studies (n = 518 patients; mean age 64.13 ± 5.83 years; 58.19 % female) were included. Mean PCL size was 33.39 ± 3.72 mm with the pancreatic head/uncinate (35.50 %) being the most common location. A mean of 2.47 ± 0.92 forceps passes were performed with a mean of 2.79 ± 0.81 microbiopsies obtained per lesion. Pooled technical success was 97.12 % (95 % CI, 93.73-98.71; I ² = 34.49) with a diagnostic yield of 79.60 % (95 % CI, 72.62-85.16; I ² = 56.00), and accuracy of 82.76 % [(95 % CI, 77.80-86.80; I ² = 0.00). The pooled serious adverse event rate was 1.08 % (95 % CI, 0.43-2.69; I ² = 0.00). Compared to conventional FNA, TTN microforceps biopsy resulted in significant improvement in diagnostic yield [OR 4.79 (95 % CI: 1.52-15.06; P = 0.007)] and diagnostic accuracy [OR 8.69 (95 % CI, 1.12-67.12; P = 0.038)], respectively. Conclusions EUS-guided TTN microforceps biopsy appears to be safe and effective for diagnosis of PCLs with improvement in diagnostic yield and accuracy when compared to FNA alone.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart of literature search results for through-the-needle microforceps biopsies of pancreatic cystic lesions. From: Moher D, Liberati A, Tetzlaff J et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2000; 6: e1000097

Fig. 2 a

Pooled technical success of through-the-needle microforceps biopsies of pancreatic cystic lesions. b Pooled diagnostic yield of through-the-needle microforceps biopsies of pancreatic cystic lesions. c Pooled diagnostic accuracy of through-the-needle microforceps biopsies of pancreatic cystic lesions.

Fig. 3 a

Pooled adverse events of through-the-needle microforceps biopsies of pancreatic cystic lesions. b Post-procedure pancreatitis events of through-the-needle microforceps biopsies of pancreatic cystic lesions. c Post-procedure bleeding events of through-the-needle microforceps biopsies of pancreatic cystic lesions. d Serious adverse events of through-the-needle microforceps biopsies of pancreatic cystic lesions.

Fig. 4 a

Diagnostic yield of through-the-needle microforceps biopsies vs conventional fine needle aspiration for pancreatic cystic lesions. b Diagnostic accuracy of through-the-needle microforceps biopsies vs conventional fine-needle aspiration for pancreatic cystic lesions.

Fig. 5 a

Funnel plot of publication bias and eggers regression test for included studies to assess through-the-needle microforceps biopsies of pancreatic cystic lesions. b Funnel plot of publication bias with Duval and Tweedie’s trim and fill method.