Facciorusso Antonio, Crinò Stefano Francesco, Ramai Daryl, Madhu Deepak, Fugazza Alessandro, Carrara Silvia, Spadaccini Marco, Mangiavillano Benedetto, Gkolfakis Paraskevas, Mohan Babu P, Hassan Cesare, Repici Alessandro
Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.
Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy.
Gastrointest Endosc. 2023 May;97(5):839-848.e5. doi: 10.1016/j.gie.2023.01.024. Epub 2023 Jan 16.
Evidence is limited on the comparative diagnostic performance of tissue sampling techniques for EUS-guided fine-needle biopsy sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare these techniques.
Rates of sample adequacy, blood contamination, and tissue integrity using fine-needle biopsy sampling needles were evaluated. Direct and indirect comparisons were performed among the slow-pull, dry-suction, modified wet-suction, or no-suction techniques. Results are expressed as risk ratio (RR) and 95% confidence interval (CI).
Overall, 9 randomized controlled trials (756 patients) were identified. On network meta-analysis, the no-suction technique was significantly inferior to the other techniques (RR, .85 [95% CI, .78-.92] vs slow pull; RR, .85 [95% CI, .78-.92] vs dry suction; RR, .83 [95% CI, .76-.90] vs modified wet suction) in terms of sample adequacy. Consequently, modified wet suction was shown to be the best technique (surface under the cumulative ranking curve score, .90), with the no-suction technique showing poorer performance in terms of sample adequacy (surface under the cumulative ranking curve score, .14). Dry suction was associated with significantly higher rates of blood contamination as compared with the slow-pull technique (RR, 1.44; 95% CI, 1.15-1.80), whereas no suction led to less blood contamination of samples in comparison with other techniques (RR, .71 [95% CI, .52-.97] vs slow pull; RR, .49 [95% CI, .36-.66] vs dry suction; RR, .57 [95% CI, .40-.81] vs modified wet suction). The modified wet-suction technique significantly outperformed dry suction in terms of tissue integrity of the sample (RR, 1.36; 95% CI, 1.06-1.75).
Modified wet suction seemed to provide high rates of integrity and adequate samples, albeit with high blood contamination. The no-suction technique performed significantly worse than other sampling strategies.
关于超声内镜引导下胰腺肿块细针穿刺活检采样技术的比较诊断性能的证据有限。我们进行了一项系统评价并采用网状Meta分析来比较这些技术。
评估使用细针穿刺活检采样针时的样本充足率、血液污染率和组织完整性。对慢抽拉、干式抽吸、改良湿式抽吸或无抽吸技术进行直接和间接比较。结果以风险比（RR）和95%置信区间（CI）表示。
总体而言，共识别出9项随机对照试验（756例患者）。在网状Meta分析中，就样本充足率而言，无抽吸技术明显劣于其他技术（与慢抽拉相比，RR为0.85 [95% CI，0.78 - 0.92]；与干式抽吸相比，RR为0.85 [95% CI，0.78 - 0.92]；与改良湿式抽吸相比，RR为0.83 [95% CI，0.76 - 0.90]）。因此，改良湿式抽吸被证明是最佳技术（累积排序曲线下面积得分，0.90），无抽吸技术在样本充足率方面表现较差（累积排序曲线下面积得分，0.14）。与慢抽拉技术相比，干式抽吸的血液污染率显著更高（RR，1.44；95% CI，1.15 - 1.80），而与其他技术相比，无抽吸导致样本的血液污染更少（与慢抽拉相比，RR为0.71 [95% CI，0.52 - 0.97]；与干式抽吸相比，RR为0.49 [95% CI，0.36 - 0.66]；与改良湿式抽吸相比，RR为0.57 [95% CI，0.40 - 0.81]）。在样本的组织完整性方面，改良湿式抽吸技术明显优于干式抽吸（RR，1.36；95% CI，1.06 - 1.75）。
改良湿式抽吸似乎能提供较高的组织完整性和充足样本，尽管血液污染率较高。无抽吸技术的表现明显比其他采样策略更差。
