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Diagnostic performance of endoscopic ultrasound through‐the‐needle microforceps biopsy of pancreatic cystic lesions: Systematic review with meta‐analysis
Author(s) -
Tacelli Matteo,
Celsa Ciro,
Magro Bianca,
Barchiesi Marco,
Barresi Luca,
Capurso Gabriele,
Arcidiacono Paolo Giorgio,
Cammà Calogero,
Crinò Stefano Francesco
Publication year - 2020
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13626
Subject(s) - medicine , endoscopic ultrasound , meta analysis , confidence interval , radiology , cytology , cyst , biopsy , pathology
Objectives Endoscopic ultrasound through‐the‐needle biopsy (EUS‐TTNB) is a useful tool for differential diagnosis among pancreatic cystic lesions (PCLs). Cystic fluid cytology (CFC) is recommended by guidelines, but its diagnostic accuracy is about 50%. The aim of this meta‐analysis is to assess the clinical impact of EUS‐TTNB in terms of technical success (TS), histological accuracy (HA) and diagnostic yield (DY). Methods Original studies in English language on EUS‐TTNB were searched in MEDLINE and EMBASE until October 2019. Diagnostic accuracy of EUS‐TTNB for identification of mucinous PCLs was calculated using individual diagnostic data of patients who underwent CFC and surgery. Results Nine studies, including 454 patients who underwent EUS‐TTNB, met the inclusion criteria for the meta‐analysis. TS and HA of EUS‐TTNB were, respectively, 98.5% (95% Confidence Interval [CI] 97.3%–99.6%) and 86.7% (95%CI 80.1–93.4). DY was 69.5% (95%CI 59.2–79.7) for EUS‐TTNB and 28.7% (95%CI 15.7–41.6) for CFC. Heterogeneity persisted significantly high in most of subgroup analyses. In the multivariate meta‐regression, cyst size was independently associated with higher DY. Sensitivity and specificity for mucinous PCLs were 88.6 and 94.7% for EUS‐TTNB, and 40 and 100% for CFC. Adverse events rate was 8.6% (95%CI 4.0–13.1). Conclusions This meta‐analysis shows that EUS‐TTNB is a feasible technique that allows a high rate of adequate specimens to be obtained for histology; in about two‐thirds of patients a specific histotype diagnosis could be assessed. The number of adverse events is slightly higher respect to standard EUS‐FNA, but complications are very rarely severe.