Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review

Abstract

Background and ObjectivesRapid on-site evaluation (ROSE) during endoscopic ultrasonography-guided fine needle aspiration (EUS–FNA) of pancreatic masses has been reported to be associated with improved adequacy and diagnostic yield. However, recent observational data on the impact of ROSE have reported conflicting results. A meta-analysis and systematic review was therefore conducted to evaluate the contribution of ROSE during EUS-FNA of pancreatic masses.MethodA systematic search was conducted in MEDLINE/Pubmed and EMBASE databases for studies comparing the efficacy of ROSE between patients in two cohorts. Outcomes considered included diagnostic adequate rate, diagnostic yield, number of needle passes, pooled sensitivity and specificity. Findings from a random-effects model were expressed as pooled risk difference (RD) with 95% confidence intervals (CIs).ResultsA total of 7 studies (1299 patients) was finally included and further analyzed in the current meta-analysis. EUS-FNA with ROSE could not improve diagnostic adequacy (RD = 0.05, 95% CI: -0.01–0.11) and diagnostic yield (RD = 0.04 95%CI: -0.05, 0.13). The number of needle passes showed no statistically significant difference with and without ROSE (RD = -0.68 95%CI: -2.35, 0.98). The pooled sensitivity and specificity of ROSE group were 0.91 (95%CI: 0.87, 0.94) and 1 (95%CI: 0.94, 1.00). The pooled sensitivity and specificity of non-ROSE group were 0.85 (95%CI: 0.80, 0.89) and 1 (95%CI: 0.95, 1.00). ROSE group and non-ROSE group showed comparable sensitivity and specificity.ConclusionCompared to historical reports of its clinical efficacy in patients with pancreatic lesions, ROSE may be not associated with an improvement of diagnostic yield, adequate rate, pooled sensitivity and specificity.

Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer

“…These findings are consistent with a recent observation that a greater number of FNA passes may be required to achieve high diagnostic sensitivity from small pancreatic masses . The presence of ROSE was not associated with a higher rate of tissue adequacy for tumor profiling, which is concordant with a recent meta‐analysis of seven studies including 1299 patients that demonstrated no improvement in diagnostic yield, tissue adequacy rates, pooled sensitivity, or pooled sensitivity with ROSE for EUS‐FNA of pancreatic masses …”

“…12 The presence of ROSE was not associated with a higher rate of tissue adequacy for tumor profiling, which is concordant with a recent meta-analysis of seven studies including 1299 patients that demonstrated no improvement in diagnostic yield, tissue adequacy rates, pooled sensitivity, or pooled sensitivity with ROSE for EUS-FNA of pancreatic masses. 13 Liquid cytology samples, including FNA rinse material, have been demonstrated to be adequate for genomic testing in institutions that have validated these types of samples. 5,[14][15][16] In a prior study from our institution, adequate material was obtained for genomic testing from residual FNA rinse or FNA-acquired body fluid specimens in all 17 cases when tumor cellularity was ≥ 10% in the aspirate.…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…Pancreatic focal lesions still represent the main indication with 80–94% sensitivity and up to 100% specificity . Rapid onsite evaluation has been introduced with up to a 15% gain in accuracy reducing the number of needle passes …”

“…[33][34][35][36][37][38] Rapid onsite evaluation has been introduced with up to a 15% gain in accuracy 39 reducing the number of needle passes. [40][41][42][43] Endoscopic ultrasonography-guided tissue acquisition can be carried out by FNA and FNB, which typically use a core biopsy needle (Fig. 2).…”

Rapid on-site evaluation of cytology for EUS- and EBUS-guided fine-needle aspiration

“…A meta-analysis of seven studies (one randomized) with a total of 1299 patients, comparing EUS-FNAC with and without ROSE, concluded that ROSE did not make a significant difference to cytological adequacy or diagnostic yield [11]. Although overall the number of needle passes was similar in the two groups, in the one study which was randomized, seven passes were made for cytology in the absence of ROSE compared to four passes in the presence of ROSE [12].…”