Endoscopic ultrasound-guided fine needle core biopsy for the diagnosis of pancreatic malignant lesions: a systematic review and Meta-Analysis

Abstract

Endoscopic ultrasound-guided fine needle core biopsy (EUS-FNB) has been used as an effective methodThe area under the sROC curve was 0.96. Subgroup analysis did not identify other factors that could substantially affect the diagnostic accuracy, such as the study design, location of study, number of centers, location of lesion, whether or not a cytopathologist was present, and so on. EUS-FNB is a reliable diagnostic tool for solid pancreatic masses and should be especially considered for pathology where histologic morphology is preferred for diagnosis.Pancreatic cancer is a devastating disease with a poor prognosis, which is partially due to delayed diagnosis because of the late onset of symptoms 1 . Despite the many advancements that have been made in medical therapy in the past decade, there are still limited treatment modalities for advanced disease. Many epidemiologic surveys have shown that the 5-year survival rate is below 5% 2,3 . A significant proportion of patients could extend their survival time by surgery if their tumors were diagnosed at an early stage 4 . So early detection and accurate staging are crucial for the right treatment choice.Tissue acquisition is of great importance to confirm diagnosis and guide treatment in pancreatic solid mass. The endoscopic ultrasound (EUS)-guided minimally invasive tissue acquisition techniques have become the standard of choice to sample pancreatic tissue that could only be biopsied through open techniques in the past 5 . The EUS method can detect lesions that are not seen by other imaging modalities and fine needle aspiration (FNA) is reported to be able to give a definitive cytological diagnosis 4 . A recent meta-analysis reported that the sensitivity and specificity of EUS-guided FNA (EUS-FNA) for pancreatic neoplasms were 85% and 98%, respectively 6 . The complication rate of EUS-FNA is approximately 1%-2% 7 . Having become widely accepted as safe and effective, EUS-FNA is considered a minimally invasive method of diagnosing pancreatic cancer 8 . Despite the widespread usage of EUS-FNA, one limitation related to this technique is that it often only provides a cytologic specimen with scant cellularity and lack of histologic architecture, which restrains us from making a complete tissue analysis for diagnosis and grade differentiation, especially for sarcomas or lymphomas 9 . As we know, in the era of molecular profiling and personalized oncologic therapies, a complete histologic sample for evaluation

Endoscopic ultrasound guided fine‐needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency

“…9 A core biopsy specimen has many supposed advantages over an aspirated cytologic specimen including better diagnostic yield and lower number of needle passes required to collect an adequate sample. [11][12][13] The aim of this study is to compare the diagnostic accuracies of EUS-FNA and EUS-CNB for solid pancreatic mass lesions. [11][12][13] The aim of this study is to compare the diagnostic accuracies of EUS-FNA and EUS-CNB for solid pancreatic mass lesions.…”

Endoscopic ultrasound guided brush/fine‐needle aspiration cytology: A 15‐month study

“…Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal (GI) tract and of adjacent organs as it offers the possibility of collecting samples, providing a definitive cytological and/or histological evidence of the presence of malignancy …”

Endoscopy Upper

“…Core biopsies (EUS‐fine needle biopsies [EUS‐FNB]) allow for analysis of histological architecture rather than just cytology, gathered with fine needle aspiration (FNA), potentially at the cost of increased risks with the larger needle. There is no convincing evidence that EUS‐FNB has an increased diagnostic accuracy compared with EUS‐FNA . The standard of care for pancreatic lesions in most centers is FNA with rapid on‐site cytopathology, which improves diagnostic yield by 10–15% .…”