Paramythiotis Daniel, Karlafti Eleni, Tsavdaris Dimitrios, Arvanitakis Konstantinos, Protopapas Adonis A, Germanidis Georgios, Kougias Leonidas, Hatzidakis Adam, Savopoulos Christos, Michalopoulos Antonios
First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
J Clin Med. 2024 May 25;13(11):3108. doi: 10.3390/jcm13113108.
Pancreatic cancer ranks as the fourth deadliest form of cancer. However, it is essential to note that not all pancreatic masses signal primary malignancy. Therefore, it is imperative to establish the correct differential diagnosis, a process further supported by pre-operative biopsy procedures. This meta-analysis aims to compare the diagnostic performance of two minimally invasive biopsy approaches for pancreatic tissue sampling: percutaneous biopsies guided by computed tomography or ultrasound, and transduodenal biopsies guided by endoscopic ultrasound (EUS). A systematic literature search was conducted in the MEDLINE and Scopus databases. The included studies analyzed the diagnostic performance of the two biopsy methods, and they were assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Statistical analysis was carried out using the RevMan and MetaDisc software packages. The statistical analysis of the results demonstrated the superiority of the percutaneous approach. Specifically, the pooled sensitivity, specificity, LR+, LR-and DOR for the percutaneous approach were 0.896 [95% CI: 0.878-0.913], 0.949 [95% CI: 0.892-0.981], 9.70 [95% CI: 5.20-18.09], 0.20 [95% CI: 0.12-0.32] and 68.55 [95% CI: 32.63-143.98], respectively. The corresponding values for EUS-guided biopsies were 0.806 [95% CI: 0.775-0.834], 0.955 [95% CI: 0.926-0.974], 12.04 [95% CI: 2.67-54.17], 0.24 [95% CI: 0.15-0.39] and 52.56 [95% CI: 13.81-200.09], respectively. Nevertheless, it appears that this statistical superiority is also linked to the selection bias favoring larger and hence more readily accessible tumors during percutaneous biopsy procedures. Concisely, our meta-analysis indicates the statistical superiority of the percutaneous approach. However, selecting the optimal biopsy method is complex, influenced by factors like patient and tumor characteristics, clinical resources, and other relevant considerations.
胰腺癌是致死率排名第四的癌症。然而，必须注意的是，并非所有胰腺肿块都意味着原发性恶性肿瘤。因此，进行正确的鉴别诊断至关重要，术前活检程序进一步支持了这一过程。本荟萃分析旨在比较两种用于胰腺组织采样的微创活检方法的诊断性能：计算机断层扫描或超声引导下的经皮活检，以及内镜超声（EUS）引导下的经十二指肠活检。在MEDLINE和Scopus数据库中进行了系统的文献检索。纳入的研究分析了这两种活检方法的诊断性能，并使用诊断准确性研究质量评估-2工具评估其偏倚风险。使用RevMan和MetaDisc软件包进行统计分析。结果的统计分析表明经皮活检方法具有优越性。具体而言，经皮活检方法的合并敏感性、特异性、阳性似然比、阴性似然比和诊断比值比分别为0.896 [95%置信区间：0.878 - 0.913]、0.949 [95%置信区间：0.892 - 0.981]、9.70 [95%置信区间：5.20 - 18.09]、0.20 [95%置信区间：0.12 - 0.32]和68.55 [95%置信区间：32.63 - 143.98]。EUS引导下活检的相应值分别为0.806 [95%置信区间：0.775 - 0.834]、0.955 [95%置信区间：0.926 - 0.974]、12.04 [95%置信区间：2.67 - 54.17]、0.24 [95%置信区间：0.15 - 0.39]和52.56 [95%置信区间：13.81 - 200.09]。然而，这种统计学上的优越性似乎也与经皮活检过程中倾向于选择更大且更容易接近的肿瘤的选择偏倚有关。简而言之，我们的荟萃分析表明经皮活检方法具有统计学上的优越性。然而，选择最佳活检方法很复杂，受患者和肿瘤特征、临床资源及其他相关因素的影响。
