比较用于超声内镜引导下胰腺实体肿块组织取样的不同针具大小和设计的准确性：一项网络荟萃分析。
Comparative accuracy of needle sizes and designs for EUS tissue sampling of solid pancreatic masses: a network meta-analysis.
机构信息
Endoscopy Unit, University of Foggia, Foggia, Italy.
University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
出版信息
Gastrointest Endosc. 2019 Dec;90(6):893-903.e7. doi: 10.1016/j.gie.2019.07.009. Epub 2019 Jul 13.
BACKGROUND AND AIMS
Variable diagnostic performance of sampling techniques during EUS-guided tissue acquisition of solid pancreatic masses based on needle type (FNA versus fine-needle biopsy [FNB]) and gauge (19-gauge vs 22-gauge vs 25-gauge) has been reported. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of EUS-guided techniques for sampling solid pancreatic masses.
METHODS
Through a systematic literature review to November 2018, we identified 27 randomized controlled trials (2711 patients) involving adults undergoing EUS-guided sampling of solid pancreatic masses that evaluated the diagnostic performance of FNA and FNB needles based on needle gauge. The primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, histologic core procurement rate, and number of needle passes. We performed pairwise and network meta-analyses and appraised the quality of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.
RESULTS
In the network meta-analysis, no specific EUS-guided tissue sampling technique was superior, based on needle type (FNA vs FNB) or gauge (19-gauge vs 22-gauge vs 25-gauge) (low-quality evidence). Specifically, there was no difference between 25-gauge FNA versus 22-gauge FNA (relative risk [RR], 1.03; 95% confidence interval [CI], 0.91-1.17) and 22-gauge FNB versus 22-gauge FNA (RR, 1.03; 95% CI, 0.89-1.18) needles for diagnostic accuracy, sample adequacy, and histologic core procurement. Findings were confirmed in sensitivity analysis restricted to studies with no rapid on-site cytologic evaluation and no use of the fanning technique.
CONCLUSION
In a network meta-analysis, no specific EUS-guided tissue sampling technique was superior with regard to diagnostic accuracy, sample adequacy, or histologic procurement rate for solid pancreatic masses, with low confidence in estimates.
背景和目的
基于针类型（细针抽吸与细针活检）和规格（19 号、22 号与 25 号），已有报道称超声内镜引导下组织获取胰腺实性肿块时不同取样技术的诊断性能存在差异。我们进行了一项系统综述和网络荟萃分析，以比较超声内镜引导下胰腺实性肿块取样技术的诊断准确性。
方法
通过系统文献回顾，截至 2018 年 11 月，我们共确定了 27 项随机对照试验（2711 例患者），这些试验涉及接受超声内镜引导下胰腺实性肿块取样的成年人，评估了基于针规格的细针抽吸与细针活检针的诊断性能。主要结局是诊断准确性。次要结局是样本充足性、组织学核心获取率和针道数量。我们进行了两两比较和网络荟萃分析，并使用 GRADE（推荐评估、制定与评价）方法评估证据质量。
结果
在网络荟萃分析中，没有特定的超声内镜引导下组织取样技术具有优势，无论是基于针类型（细针抽吸与细针活检）还是规格（19 号、22 号与 25 号）（低质量证据）。具体来说，25 号细针抽吸与 22 号细针抽吸之间（相对风险 [RR]，1.03；95%置信区间 [CI]，0.91-1.17）和 22 号细针活检与 22 号细针抽吸之间（RR，1.03；95% CI，0.89-1.18）在诊断准确性、样本充足性和组织学核心获取方面并无差异。在仅限于无快速现场细胞学评估和不使用扇形技术的研究的敏感性分析中，发现了同样的结果。
结论
在网络荟萃分析中，没有特定的超声内镜引导下组织取样技术在诊断准确性、样本充足性或组织学获取率方面具有优势，且估计结果的可信度较低。
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