Comparison between EUS-guided fine-needle biopsy with or without rapid on-site evaluation for tissue sampling of solid pancreatic lesions: A systematic review and meta-analysis

Abstract

The benefit of rapid on-site evaluation (ROSE) on the diagnostic accuracy of EUS–guided fine-needle biopsy (EUS-FNB) in patients with pancreatic masses is still matter of debate. Aim of our meta-analysis is to compare the diagnostic outcomes of these two tissue acquisition strategies. Computerized bibliographic search on the main databases was performed through December 2021 and 8 studies were identified (2147 patients). The primary outcome was sample adequacy. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test and summary estimates were expressed in terms of odds ratio (OR) or mean difference and 95% confidence Interval (CI). There was no difference in terms of baseline variables between the two groups. Pooled sample adequacy was 95.5% (95% CI 93.2%–97.8%) and 88.9% (83.4%-94.5%) in the EUS-FNB + ROSE and EUS-FNB groups, respectively (OR = 2.05, 0.94–4.49; P = 0.07). Diagnostic accuracy resulted significantly superior in the EUS-FNB + ROSE group (OR = 2.49, 1.08–5.73; P = 0.03), particularly when the analysis was restricted to reverse bevel needle (OR = 3.24, 1.19–8.82, P = 0.02), whereas no statistical difference was observed when newer end-cutting needles were used (OR = 0.71, 0.29–3.61, P = 0.56). Diagnostic sensitivity was not significantly different between the two groups (OR = 1.94, 0.84–4.49; P = 0.12), whereas pooled specificity was 100% with both approaches. The number of needle passes needed to obtain diagnostic samples was not significantly different (mean difference 0.07,-0.22 to 0.37; P = 0.62). Our meta-analysis stands for a non-superiority of EUS-FNB + ROSE over EUS-FNB with newer end-cutting needles, whereas ROSE could have still a role when reverse bevel needles are used.

Establishing the optimal number of passes during EUS-FNB for diagnosis of pancreatic solid lesions: Prospective multicenter study

“…In contrast, the accuracy remained the same after the third pass. The overall rate of accuracy reported in the present study agrees with recent literature [4][5][6][20][21][22].…”

Do Biliary Stents Affect EUS-Guided Tissue Acquisition (EUS-TA) in Solid Pancreatic Lesions Determining Biliary Obstruction? A Literature Review with Meta-Analysis

“…Therefore, it is possible that a larger number of patients who underwent EUS-FNB underwent biliary drainage using SEMSs due to evidence demonstrating their superiority over plastic stents [ 26 ]. In other words, both EUS-FNB and SEMSs have become widespread during recent decades [ 27 , 28 , 29 , 30 ], and it is possible that the negative impact of biliary stents was related to the more frequent use of SEMSs rather than plastic stents.…”

Endoscopic ultrasound-guided tissue acquisition beyond the pancreas

“…5 ) [ 38 ]. Even though most SETs are small, grow slowly, and are clinically irrelevant, a subset of these tumors, usually GISTs, are potentially malicious [ 39 , 40 ]. Thus, a proper biopsy specimen with EUS is crucial to establishing an accurate diagnosis.…”

“…For that purpose, EUS-guided cytology or biopsy methods—namely FNA, Tru-Cut biopsy and FNB—provide favorable diagnostic results. Cytology with immunocytochemical staining may also increase the diagnostic yield for GI SETs, whereas the role of ROSE when using FNB, as in the case of pancreatic masses [ 40 ], is uncertain.…”