Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Endoscopy. 2021 Apr;53(4):411-423. doi: 10.1055/a-1206-5552. Epub 2020 Aug 6.
Endoscopic ultrasound (EUS)-guided tissue acquisition is extensively used, but the optimal sampling device is still a matter of debate. We performed meta-analyses on studies comparing fine-needle aspiration (FNA) with fine-needle biopsy (FNB) needles, and studies comparing different FNB needles.
Online databases were searched for randomized controlled trials (RCTs) of at least 50 cases with a suspected solid pancreatic or nonpancreatic lesion that compared FNA with FNB needles. Outcome measures included diagnostic accuracy, adequacy, number of passes, presence of tissue cores, and adverse events. We also performed meta-regression analysis on the effect of FNB design on diagnostic accuracy. Quality was assessed using the QUADAS-2 tool.
18 RCTs comparing FNA with FNB needles were included. FNB provided a higher pooled diagnostic accuracy (87 % vs. 80 %; = 0.02) and tissue core rate (80 % vs. 62 %; = 0.002), and allowed diagnosis with fewer passes ( = 0.03), in both pancreatic and nonpancreatic lesions. A total of 93 studies were included comparing different FNB devices. Pooled diagnostic accuracy was higher for forward-facing bevel needles than for the reverse bevel needle. In this analysis, study quality was low and heterogeneity was high ( = 80 %).
FNB outperformed FNA when sampling pancreatic and nonpancreatic lesions. Forward-facing bevel FNB needles seemed to outperform the reverse bevel FNB needle, but the low quality of evidence prevents us from making strong recommendations on the optimal FNB design.
内镜超声（EUS）引导下组织获取被广泛应用，但最佳采样设备仍存在争议。我们对比较细针抽吸（FNA）与细针活检（FNB）针的研究以及比较不同 FNB 针的研究进行了荟萃分析。
在线数据库中搜索了至少 50 例疑似胰腺或非胰腺实体病变的随机对照试验（RCT），这些研究比较了 FNA 与 FNB 针。主要结局指标包括诊断准确性、充分性、穿刺次数、组织芯数量和不良事件。我们还对 FNB 设计对诊断准确性的影响进行了元回归分析。使用 QUADAS-2 工具评估质量。
共纳入 18 项比较 FNA 与 FNB 针的 RCT。FNB 提供了更高的汇总诊断准确性（87%比 80%；P=0.02）和组织芯率（80%比 62%；P=0.002），并且允许在胰腺和非胰腺病变中通过更少的穿刺次数获得诊断（P=0.03）。共有 93 项比较不同 FNB 设备的研究被纳入。与反向斜面针相比，正向斜面针的汇总诊断准确性更高。在这项分析中，研究质量较低，异质性较高（P=80%）。
在采样胰腺和非胰腺病变时，FNB 优于 FNA。正向斜面 FNB 针似乎优于反向斜面 FNB 针，但证据质量低，无法对最佳 FNB 设计提出强烈建议。
