Background and aims: There is limited evidence on the comparative diagnostic performance of newer end-cutting fine-needle biopsy (FNB) needles for tissue sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of available FNB needles for sampling of solid pancreatic lesions.background METHODS: A systematic literature review (MEDLINE and Cochrane Database) was conducted for studies evaluating the accuracy of newer FNB needles in adults undergoing EUS-guided sampling of solid pancreatic masses. Primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and adverse event rate. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE methodology. Results: Overall, 16 RCTs (1934 patients) were identified. On network meta-analysis, Franseen needle significantly outperformed reverse bevel needle (risk ratio [RR] 1.21, 1.05-1·40 for accuracy and 1·31, 1·05-1·22 for adequacy) and fine-needle aspiration (FNA: RR 1·21, 1·01-1·25 for accuracy and 1·07, 1·02-1·13 for adequacy). Likewise, Fork-tip needle was significantly superior to reverse bevel needle (RR 1·17, 1·03-1·33 for accuracy and 1·09, 1·02-1·16 for adequacy) and to FNA (RR 1·09, 1·01-1·19 for accuracy and 1·03, 1·01-1·07 for adequacy). Other comparisons did not achieve statistical significance. As a consequence, Franseen (SUCRA score 0·89 for accuracy and 0·94 for adequacy) and Fork-tip needle (SUCRA score 0·76 for accuracy and 0·73 for adequacy) ranked as the two highest-performing FNB needles. When considering different needle sizes, 25G Franseen and 25G Fork-tip needle were not superior to 22G reverse bevel needle (RR 1·18, 0·96-1·46 and RR 1·04, 0·62-1·52). None of the tested needles resulted significantly superior to the other FNB devices nor to FNA when rapid on-site cytological evaluation was available.results CONCLUSIONS: Franseen and Fork-tip needle, particularly with 22G size, showed the highest performance for tissue sampling of pancreatic masses, with low confidence in estimates. Conclusion:
Comparative Diagnostic Performance of End-cutting Fine-needle Biopsy Needles for Endoscopic Ultrasound Tissue Sampling of Solid Pancreatic Masses: A Network Meta-analysis
Facciorusso, Antonio
2022-01-01
Abstract
Background and aims: There is limited evidence on the comparative diagnostic performance of newer end-cutting fine-needle biopsy (FNB) needles for tissue sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of available FNB needles for sampling of solid pancreatic lesions.background METHODS: A systematic literature review (MEDLINE and Cochrane Database) was conducted for studies evaluating the accuracy of newer FNB needles in adults undergoing EUS-guided sampling of solid pancreatic masses. Primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and adverse event rate. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE methodology. Results: Overall, 16 RCTs (1934 patients) were identified. On network meta-analysis, Franseen needle significantly outperformed reverse bevel needle (risk ratio [RR] 1.21, 1.05-1·40 for accuracy and 1·31, 1·05-1·22 for adequacy) and fine-needle aspiration (FNA: RR 1·21, 1·01-1·25 for accuracy and 1·07, 1·02-1·13 for adequacy). Likewise, Fork-tip needle was significantly superior to reverse bevel needle (RR 1·17, 1·03-1·33 for accuracy and 1·09, 1·02-1·16 for adequacy) and to FNA (RR 1·09, 1·01-1·19 for accuracy and 1·03, 1·01-1·07 for adequacy). Other comparisons did not achieve statistical significance. As a consequence, Franseen (SUCRA score 0·89 for accuracy and 0·94 for adequacy) and Fork-tip needle (SUCRA score 0·76 for accuracy and 0·73 for adequacy) ranked as the two highest-performing FNB needles. When considering different needle sizes, 25G Franseen and 25G Fork-tip needle were not superior to 22G reverse bevel needle (RR 1·18, 0·96-1·46 and RR 1·04, 0·62-1·52). None of the tested needles resulted significantly superior to the other FNB devices nor to FNA when rapid on-site cytological evaluation was available.results CONCLUSIONS: Franseen and Fork-tip needle, particularly with 22G size, showed the highest performance for tissue sampling of pancreatic masses, with low confidence in estimates. Conclusion:I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
