Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, MMC 36, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
Department of Internal Medicine, The Wright Center for Community Health, 01 S Washington Ave Suite 1000, Scranton, PA, USA.
Dig Dis Sci. 2022 Jun;67(6):2552-2561. doi: 10.1007/s10620-021-07066-3. Epub 2021 Jun 4.
Patients with chronic pancreatitis (CP) are at a higher risk of developing pancreatic adenocarcinoma compared the general population with an estimated 5% risk of developing pancreatic cancer in 20 years. Endoscopic ultrasound fine needle aspiration (EUS-FNA) of solid pancreatic lesions (SPL) has an excellent sensitivity (85-90%) and specificity (98-100%) for diagnosing pancreatic malignancy. However, data on the performance characteristics of EUS-FNA in CP are mixed.
In this systematic review and meta-analysis, we aim to examine data from published studies on the diagnostic performance of EUS-FNA in detecting pancreatic malignancy in CP.
We conducted a comprehensive search of MEDLINE, Cochrane, EMBASE, Scopus databases for studies published in English language that reported performance characteristics of EUS-FNA for SPL up to November 2020. Two reviewers independently conducted screening, full text review and data extraction according to the PRISMA guidelines. Quality of included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. The parameters of interest were sensitivity, specificity, negative, and positive likelihood ratios. Cochran Q test and I statistics were used to determine the between-study heterogeneity. Funnel plots were used to describe publication bias.
A total of 6753 studies were identified on initial search. Studies that reported EUS-FNA of cystic pancreas lesions were excluded. Eight studies met the inclusion criteria. Seven studies were retrospective, and one was prospective. A total of 593 patients with CP underwent EUS-FNA for SPL. The pooled sensitivity of EUS-FNA was 65% (95% CI 52.6-75.6%, I = 44%), specificity was 96.8% (75-99.7%, I = 89%), negative likelihood ratio (NLR) 41.4 (11.1-149.6, I = 70%), positive likelihood ratio (PLR) 24.1 (2.8-208, I = 90%). The pooled data from seven studies that compared 901 non-CP vs. 127 CP showed that the sensitivity of EUS-FNA in diagnosing pancreatic malignancy was 91.5 vs. 65.3% [OR (95% CI) 5.5 (2.9-10.2), I: 31.8%]. The specificity pooled from six studies [333 non-CP vs. 357 CP] was 95.9% vs. 82.4%, [OR (95% CI) 1.3 (0.2-9.8), I = 73%]. The risk of bias was serious in one study, low in four studies and moderate in three studies.
This pooled meta-analysis shows a low sensitivity of EUS-FNA in diagnosing malignancy in CP patients with SPL in comparison to patients without CP. Modalities such as EUS-fine needle biopsy have high sensitivity and specificity for diagnosing pancreatic cancer and should be considered in patients with CP and suspected pancreatic malignancy.
与普通人群相比，慢性胰腺炎（CP）患者发生胰腺腺癌的风险更高，估计 20 年内患胰腺癌的风险为 5%。超声内镜引导下细针抽吸术（EUS-FNA）对实性胰腺病变（SPL）的诊断胰腺恶性肿瘤具有极好的敏感性（85-90%）和特异性（98-100%）。然而，EUS-FNA 在 CP 中的性能特征的数据存在差异。
在本系统评价和荟萃分析中，我们旨在研究已发表的关于 EUS-FNA 检测 CP 中胰腺恶性肿瘤的诊断性能的数据。
我们对 MEDLINE、Cochrane、EMBASE 和 Scopus 数据库进行了全面检索，以查找截至 2020 年 11 月发表的报告 EUS-FNA 检测 SPL 胰腺恶性肿瘤的性能特征的英文研究。两位审查员根据 PRISMA 指南独立进行筛选、全文审查和数据提取。使用非随机干预研究的偏倚风险（ROBINS-I）工具评估纳入研究的质量。感兴趣的参数是敏感性、特异性、阴性和阳性似然比。Cochran Q 检验和 I 统计用于确定研究间的异质性。漏斗图用于描述发表偏倚。
最初搜索共确定了 6753 项研究。排除了报告 EUS-FNA 囊性胰腺病变的研究。符合纳入标准的有 8 项研究。其中 7 项为回顾性研究，1 项为前瞻性研究。593 例 CP 患者接受了 EUS-FNA 检查 SPL。EUS-FNA 的汇总敏感性为 65%（95%CI 52.6-75.6%，I=44%），特异性为 96.8%（75-99.7%，I=89%），阴性似然比（NLR）为 41.4（11.1-149.6，I=70%），阳性似然比（PLR）为 24.1（2.8-208，I=90%）。比较 901 例非 CP 与 127 例 CP 的 7 项研究的数据显示，EUS-FNA 诊断胰腺恶性肿瘤的敏感性分别为 91.5%和 65.3%[比值比（95%CI）5.5（2.9-10.2），I：31.8%]。来自 6 项研究[333 例非 CP 与 357 例 CP]的特异性汇总为 95.9%和 82.4%[比值比（95%CI）1.3（0.2-9.8），I=73%]。一项研究的偏倚风险较高，四项研究的偏倚风险较低，三项研究的偏倚风险为中度。
本荟萃分析表明，与无 CP 的患者相比，EUS-FNA 对 CP 患者 SPL 中恶性肿瘤的诊断敏感性较低。EUS-细针活检等方法对诊断胰腺癌具有较高的敏感性和特异性，应考虑在 CP 患者和疑似胰腺恶性肿瘤的患者中使用。
