Gastroenterology Unit, University of Foggia, Foggia, Italy.
University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Gastrointest Endosc. 2020 Jul;92(1):1-8.e3. doi: 10.1016/j.gie.2020.01.038. Epub 2020 Feb 1.
There is currently limited evidence supporting the use of EUS-guided through-the-needle biopsy for sampling pancreatic cystic lesions. The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of through-the-needle biopsy for sampling of pancreatic cysts.
A bibliographic search on the main databases was performed in September 2019. Pooled effects were calculated using a random-effects model by means of the DerSimonian and Laird test. The primary outcome was sample adequacy. Additional endpoints were diagnostic accuracy, optimal histologic core procurement, mean number of needle passes, pooled specificity, and sensitivity. Adverse event rates were also analyzed.
Eleven studies enrolling 490 patients were included. Eight articles compared through-the-needle biopsy with cytology/cystic fluid analysis. Most patients were female, and the body/tail was the most frequent location of cystic lesions. Sample adequacy with through-the-needle biopsy was 85.3% (78.2%-92.5%), and subanalysis performed according to cyst morphology, size, and location confirmed the result. Through-the-needle biopsy clearly outperformed FNA both in terms of sample adequacy (odds ratio, 4.83; 95% confidence interval, 1.63-14.31; P =.004) and diagnostic accuracy (odds ratio, 3.44; 95% confidence interval, 1.32-8.96; P =.01). The pooled diagnostic accuracy rate, sensitivity, and specificity of through-the-needle biopsy were 78.8%, 82.2%, and 96.8%, respectively. A mean of 3.121 (2.98-3.25) passes through the cyst was needed to obtain adequate histologic samples. The incidence rates of mild bleeding and pancreatitis were 4% and 2%, respectively.
Our meta-analysis speaks in favor of the use of through-the-needle biopsy as a safe and effective tool in EUS-guided tissue acquisition of pancreatic cysts.
目前，支持使用超声内镜引导下经皮穿刺活检术对胰腺囊性病变进行取样的证据有限。本荟萃分析的目的是提供经皮穿刺活检术对胰腺囊肿取样的诊断性能的汇总估计。
我们于 2019 年 9 月在主要数据库上进行了文献检索。使用 DerSimonian 和 Laird 检验的随机效应模型计算汇总效应。主要结局是样本充足性。其他终点包括诊断准确性、最佳组织芯获取、平均穿刺针数、汇总特异性和敏感性。还分析了不良事件发生率。
共纳入 11 项纳入 490 例患者的研究。8 篇文章比较了经皮穿刺活检术与细胞学/囊液分析。大多数患者为女性，囊性病变最常见的部位是体尾部。经皮穿刺活检术的样本充足率为 85.3%（78.2%-92.5%），根据囊肿形态、大小和位置进行的亚组分析证实了这一结果。经皮穿刺活检术在样本充足性（优势比，4.83；95%置信区间，1.63-14.31；P =.004）和诊断准确性（优势比，3.44；95%置信区间，1.32-8.96；P =.01）方面均明显优于 FNA。经皮穿刺活检术的汇总诊断准确性、敏感性和特异性分别为 78.8%、82.2%和 96.8%。获得充足的组织学样本平均需要 3.121 次（2.98-3.25）穿过囊肿。轻度出血和胰腺炎的发生率分别为 4%和 2%。
我们的荟萃分析支持将经皮穿刺活检术作为超声内镜引导下胰腺囊肿组织获取的一种安全有效的工具。
