Departments of Anesthesiology.
Gastroenterology, The First People's Hospital of Chenzhou, Chenzhou, Hunan, China.
J Clin Gastroenterol. 2022 Sep 1;56(8):668-678. doi: 10.1097/MCG.0000000000001702. Epub 2022 Apr 14.
The superiority between endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is still a debate. The purpose of this meta-analysis was to compare the diagnostic value and safety of these 2 needles in sampling of all solid lesions and separately pancreatic lesions.
PubMed, EMBASE, and the Cochrane library were searched for randomized controlled studies that reported the comparison of FNA and FNB in solid mass. Outcome measures included diagnostic accuracy, number of needle passes, diagnostic adequacy, presence of tissue cores, and adverse events. Standard error, upper and lower confidence intervals at 95% confidence interval for the risk were obtained using Review Manager Version 5.3 which was also used to generate forest plots for pooled analysis. The random or fixed effect model was applied depending on the heterogeneity ( I2 ).
Eighteen randomized control trial studies with a total of 2718 patients (1141 patients with EUS-FNA, 1108 with EUS-FNB, and remaining 469 patients were sampled with both needles alternatively) were included in the meta-analysis.FNB group has relatively good diagnostic accuracy relative risk (RR): 0.94, 0.92-0.97; P =0.0002), diagnostic adequacy (RR: 0.95, 0.9-1.0; P =0.04) and high quality histologic yield compared (RR: 0.77, 0.64-0.93; P =0.007) with the FNA group in solid gastrointestinal lesions, and the number of needle passes to obtain sufficient tissue (mean difference: 0.54, 0.45-0.64; P <0.00001) was lower in the FNB group. For solid pancreatic disease only, there was no difference in diagnostic accuracy (RR: 0.97, 0.93-1.01, P =0.13) or quality histologic yield (RR: 0.60, 0.29-1.23; P =0.16). The rate of adverse events (RR: 1.04, 0.48-2.29; P =0.92) did not significantly differ between FNA and FNB groups.
In solid gastrointestinal lesions, FNB is associated with a relatively better diagnostic adequacy, diagnostic adequacy and tissue cores rates, and less number of needle passes. For solid pancreatic disease only, there is no difference in diagnostic accuracy or tissue cores rates.
内镜超声引导下细针抽吸术（EUS-FNA）与内镜超声引导下细针活检术（EUS-FNB）之间的优势仍存在争议。本荟萃分析的目的是比较这两种针在所有实体病变和单独胰腺病变取样中的诊断价值和安全性。
检索了 PubMed、EMBASE 和 Cochrane 图书馆中比较 FNA 和 FNB 在实体肿块中的应用的随机对照研究。主要观察指标包括诊断准确性、针数、诊断充分性、组织芯存在率和不良事件。使用 Review Manager Version 5.3 获得 95%置信区间的风险标准误差、上下限，该软件也用于生成合并分析的森林图。根据异质性（I2），采用随机或固定效应模型。
共纳入 18 项随机对照试验研究，共 2718 例患者（EUS-FNA 组 1141 例，EUS-FNB 组 1108 例，其余 469 例患者分别用两种针交替取样）。与 FNA 组相比，FNB 组在胃肠道实体病变中具有相对较高的诊断准确性（相对危险度：0.94，0.92-0.97；P =0.0002）、诊断充分性（相对危险度：0.95，0.9-1.0；P =0.04）和高质量的组织学产量（相对危险度：0.77，0.64-0.93；P =0.007），且获得足够组织的针数较少（平均差值：0.54，0.45-0.64；P <0.00001）。仅在胰腺实体疾病中，两种方法的诊断准确性（相对危险度：0.97，0.93-1.01，P =0.13）或高质量组织学产量（相对危险度：0.60，0.29-1.23；P =0.16）均无差异。不良事件发生率（相对危险度：1.04，0.48-2.29；P =0.92）在 FNA 和 FNB 组之间无显著差异。
在胃肠道实体病变中，FNB 与相对更好的诊断充分性、诊断充分性和组织芯率以及较少的针数相关。仅在胰腺实体疾病中，两种方法的诊断准确性或组织芯率无差异。
