Open AccessEndoscopic ultrasonography‐guided tissue acquisition for small solid pancreatic lesions: Does the size matter?
Author(s) -
Nakai Yousuke,
Hamada Tsuyoshi,
Hakuta Ryunosuke,
Ishigaki Kazunaga,
Saito Kei,
Saito Tomotaka,
Takahara Naminatsu,
Mizuno Suguru,
Kogure Hirofumi,
Koike Kazuhiko,
Fujishiro Mitsuhiro
Publication year - 2022
Publication title -
den open
Language(s) - English
Resource type - Journals
ISSN - 2692-4609
DOI - 10.1002/deo2.52
Subject(s) - endoscopic ultrasonography , ultrasonography , radiology , medicine , endoscopy
Endoscopic ultrasonography‐guided tissue acquisition (EUS‐TA) is now an established technique to obtain the pathological diagnosis of solid pancreatic lesions (SPLs), but the diagnosis of small SPLS by EUS‐TA can still be difficult. We conducted a literature review and a meta‐analysis on the diagnostic yield of EUS‐TA according to the tumor size. In a meta‐analysis of 33 studies with 6883 cases, a pooled odds ratio (OR) of sensitivity was significantly higher in SPLs of >20 mm (OR 1.64, p = 0.02) and in SPLs of >10 mm (OR 3.05, p = 0.01), but not in SPLs of >30 mm (OR 1.18, p = 0.46). The meta‐analysis of accuracy also showed a similar trend: OR of 1.59 in SPLs of >20 mm ( p < 0.01) and OR of 3.27 in SPLs of >10 mm ( p < 0.01) and OR of 1.03 in SPLs of >30 mm ( p = 0.87). The use of a 25‐gauge needle tended to improve sensitivity in small SPLs, though not statistically significant: OR of 1.25 and 2.82 in studies with and without a 25‐gauge needle ( p = 0.08). The use of fine needle biopsy needles, slow pull method, and rapid on‐site evaluation did not significantly improve sensitivity in small SPLs. EUS‐TA for small SPLs, especially neuroendocrine neoplasms, is reported to have a high risk of adverse events. In summary, the diagnostic yield and safety of EUS‐TA for small (<20 mm) SPLs still needs improvement, and the best needle and technique for small SPLs should be further investigated.