Sadeghi Anahita, Mohamadnejad Mehdi, Islami Farhad, Keshtkar Abbas, Biglari Mohammad, Malekzadeh Reza, Eloubeidi Mohamad A
Liver and Pancreatobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
American Cancer Society, Atlanta, Georgia, USA.
Gastrointest Endosc. 2016 Feb;83(2):290-8.e1. doi: 10.1016/j.gie.2015.09.024. Epub 2015 Sep 28.
EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures.
A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for EUS-FNA of extrahepatic biliary stricture. A Quality Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the quality of the selected studies. Several sensitivity analyses were performed to assess the effect of the quality of the studies on the accuracy of the final results of the meta-analysis.
Twenty studies involving 957 patients met inclusion criteria and were included in the meta-analysis. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% confidence interval [CI], 74%-86%), and 97% (95% CI, 94%-99%), respectively. The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the negative likelihood ratio was 0.26 (95% CI, 0.18-0.38). The pooled diagnostic odds ratio for diagnosing a malignant biliary stricture was 70.53 (95% CI, 38.62-128.82). The area under the receiver-operating characteristic curve was 0.97. Sensitivity analyses showed that the quality of the included studies did not affect the accuracy of the final results of the meta-analysis.
This meta-analysis demonstrates that EUS-FNA is sensitive and highly specific for diagnosing malignancy in biliary strictures. Further studies are needed to compare EUS--FNA with emerging methods including cholangioscopy-guided biopsy and laser endomicroscopy.
超声内镜引导下细针穿刺抽吸术（EUS-FNA）越来越多地用于肝外胆管狭窄的组织诊断。本研究的目的是确定EUS-FNA对恶性胆管狭窄的诊断率。
由两名审阅者对评估EUS-FNA在胆管狭窄中准确性的研究进行全面的文献综述。进行荟萃分析以确定肝外胆管狭窄EUS-FNA的敏感性、特异性、似然比和诊断比值比的合并估计值。使用诊断准确性研究质量评估问卷来评估所选研究的质量。进行了几项敏感性分析，以评估研究质量对荟萃分析最终结果准确性的影响。
20项涉及957例患者的研究符合纳入标准并被纳入荟萃分析。EUS-FNA诊断恶性胆管狭窄的合并敏感性和特异性分别为80%（95%置信区间[CI]，74%-86%）和97%（95%CI，94%-99%）。合并阳性似然比为12.35（95%CI，7.37-20.72），阴性似然比为0.26（95%CI，0.18-0.38）。诊断恶性胆管狭窄的合并诊断比值比为(70.53)（95%CI，38.62-128.82）。受试者工作特征曲线下面积为0.97。敏感性分析表明，纳入研究的质量不影响荟萃分析最终结果的准确性。
这项荟萃分析表明，EUS-FNA对胆管狭窄恶性肿瘤的诊断具有敏感性和高度特异性。需要进一步研究将EUS-FNA与包括胆管镜引导活检和激光共聚焦内镜在内的新兴方法进行比较。
