22 号和 25 号针在内镜超声引导下对胰腺实性病变进行细针抽吸的诊断准确性：一项荟萃分析。
The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis.
机构信息
Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73117, USA.
出版信息
Endoscopy. 2013;45(2):86-92. doi: 10.1055/s-0032-1325992. Epub 2013 Jan 10.
BACKGROUND AND STUDY AIMS
It is uncertain if needle gauge impacts the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass lesions. Our aim was to use meta-analysis to more robustly define the diagnostic accuracy of EUS-FNA for pancreatic masses using 22 G and 25 G needles.
PATIENTS AND METHODS
Studies were identified by searching nine medical databases for reports published between 1994 and 2011, using a reproducible search strategy comprised of relevant terms. Only studies comparing the overall diagnostic accuracy of 22 G vs. 25 G EUS needles that used surgical histology or at least 6 months clinical follow up for a gold standard were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. When required, the original investigators were contacted to provide additional data. Pooling was conducted by both fixed-effects and random-effects models. Diagnostic characteristics (sensitivity, specificity, positive and negative likelihood ratios) with 95% confidence intervals (CIs) were calculated.
RESULTS
Eight studies involving 1292 subjects met the defined inclusion criteria. Of the 1292 patients, 799 were in the 22 G group and 565 were in the 25 G group (both needles were used in 72 patients). The pooled sensitivity and specificity of the 22 G needle were 0.85 (95%CI 0.82-0.88) and 1 (95%CI 0.98-1) respectively. The pooled sensitivity and specificity of the 25 G needle were 0.93 (95%CI 0.91-0.96) and 0.97 (95%CI 0.93-0.99) respectively. The bivariate generalized linear random-effect model indicated that the 25 G needle is associated with a higher sensitivity (P = 0.0003) but comparable specificity (P = 0.97) to the 22 G needle.
CONCLUSIONS
This meta-analysis suggests 25 G needle systems are more sensitive than 22 G needles for diagnosing pancreatic malignancy.
背景和研究目的
目前尚不确定针号是否会影响内镜超声引导下细针抽吸术（EUS-FNA）诊断胰腺肿块病变的准确性。我们的目的是使用荟萃分析更有力地定义使用 22G 和 25G 针进行胰腺肿块 EUS-FNA 的诊断准确性。
患者和方法
通过搜索九个医学数据库，使用由相关术语组成的可重复搜索策略，确定 1994 年至 2011 年期间发表的报告，以识别研究。仅包括比较 22G 与 25G EUS 针的总体诊断准确性的研究，这些研究使用手术组织学或至少 6 个月的临床随访作为金标准。两名审查员独立对确定的研究进行方法评分并提取相关数据。如有必要，联系原始研究人员以提供其他数据。通过固定效应和随机效应模型进行合并。计算了 95%置信区间（CI）的诊断特征（敏感性、特异性、阳性和阴性似然比）。
结果
有 8 项研究共涉及 1292 名患者符合既定纳入标准。在 1292 名患者中，799 名患者接受 22G 针治疗，565 名患者接受 25G 针治疗（72 名患者同时使用两种针）。22G 针的合并敏感性和特异性分别为 0.85（95%CI 0.82-0.88）和 1（95%CI 0.98-1）。25G 针的合并敏感性和特异性分别为 0.93（95%CI 0.91-0.96）和 0.97（95%CI 0.93-0.99）。双变量广义线性随机效应模型表明，与 22G 针相比，25G 针的敏感性更高（P = 0.0003），但特异性相当（P = 0.97）。
结论
这项荟萃分析表明，25G 针系统在诊断胰腺恶性肿瘤方面比 22G 针更敏感。
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