McCarty Thomas, Rustagi Tarun
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.
Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States.
Endosc Int Open. 2020 Oct;8(10):E1280-E1290. doi: 10.1055/a-1194-4085. Epub 2020 Sep 22.
Given variable diagnostic yield of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for pancreatic cystic lesions (PCLs), a through-the-needle (TTN) microforceps biopsy device passed through a 19-gauge FNA needle has been devised to improve tissue sampling. This was a systematic review and meta-analysis to evaluate the feasibility, diagnostic yield, and safety of EUS-guided TTN microforceps biopsy for diagnosis of PCLs. Individualized searches were developed in accordance with PRISMA and MOOSE guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, diagnostic yield, accuracy, and procedure-associated adverse events (AEs) as well as comparison to conventional FNA. Eleven studies (n = 518 patients; mean age 64.13 ± 5.83 years; 58.19 % female) were included. Mean PCL size was 33.39 ± 3.72 mm with the pancreatic head/uncinate (35.50 %) being the most common location. A mean of 2.47 ± 0.92 forceps passes were performed with a mean of 2.79 ± 0.81 microbiopsies obtained per lesion. Pooled technical success was 97.12 % (95 % CI, 93.73-98.71; I = 34.49) with a diagnostic yield of 79.60 % (95 % CI, 72.62-85.16; I = 56.00), and accuracy of 82.76 % [(95 % CI, 77.80-86.80; I = 0.00). The pooled serious adverse event rate was 1.08 % (95 % CI, 0.43-2.69; I = 0.00). Compared to conventional FNA, TTN microforceps biopsy resulted in significant improvement in diagnostic yield [OR 4.79 (95 % CI: 1.52-15.06; = 0.007)] and diagnostic accuracy [OR 8.69 (95 % CI, 1.12-67.12; = 0.038)], respectively. EUS-guided TTN microforceps biopsy appears to be safe and effective for diagnosis of PCLs with improvement in diagnostic yield and accuracy when compared to FNA alone.
鉴于内镜超声（EUS）引导下细针穿刺抽吸（FNA）对胰腺囊性病变（PCL）的诊断率存在差异，一种经针（TTN）微钳活检装置已被设计出来，该装置可通过19号FNA针，以改善组织取样。这是一项系统评价和荟萃分析，旨在评估EUS引导下TTN微钳活检诊断PCL的可行性、诊断率和安全性。根据PRISMA和MOOSE指南制定了个性化检索策略。这是一项累积荟萃分析，通过使用随机效应模型估计的比率计算合并比例。测量的结果包括合并的技术成功率、诊断率、准确性和与操作相关的不良事件（AE），以及与传统FNA的比较。纳入了11项研究（n = 518例患者；平均年龄64.13±5.83岁；58.19%为女性）。PCL的平均大小为33.39±3.72mm，胰头/钩突部（35.50%）是最常见的部位。平均进行了2.47±0.92次钳夹操作，每个病变平均获得2.79±0.81次微生物活检。合并的技术成功率为97.12%（95%CI，93.73 - 98.71；I² = 34.49），诊断率为79.60%（95%CI，72.62 - 85.16；I² = 56.00），准确性为82.76%（95%CI，77.80 - 86.80；I² = 0.00）。合并的严重不良事件发生率为1.08%（95%CI，0.43 - 2.69；I² = 0.00）。与传统FNA相比，TTN微钳活检在诊断率[比值比（OR）4.79（95%CI：1.52 - 15.06；P = 0.007）]和诊断准确性[OR 8.69（95%CI，1.12 - 67.12；P = 0.038）]方面均有显著提高。EUS引导下TTN微钳活检对于PCL的诊断似乎是安全有效的，与单独的FNA相比，其诊断率和准确性有所提高。
