Comparative diagnostic accuracy of EUS needles in solid pancreatic masses: a network meta-analysis

Samuel Han; Furqan Bhullar; Omar Alaber; Ayesha Kamal; Puanani Hopson; Kavin Kanthasamy; Sarah Coughlin; Livia Archibugi; Nikhil Thiruvengadam; Christopher Moreau; David Jin; Pedram Paragomi; Francisco Valverde-López; Sajan Nagpal; Cemal Yazici; Georgios Papachristou; Peter J Lee; Venkata Akshintala; on behalf of the Collaborative Alliance for Pancreatic Education and Research (CAPER)

doi:10.1055/a-1381-7301

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(06): E853-E862
DOI: 10.1055/a-1381-7301

Original article

Comparative diagnostic accuracy of EUS needles in solid pancreatic masses: a network meta-analysis

Authors

Samuel Han

¹Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
Furqan Bhullar

²Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
Omar Alaber

³Division of Gastroenterology and Liver Disease, University Hospitals, Cleveland, Ohio, United States
Ayesha Kamal

²Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
Puanani Hopson

⁴Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Kavin Kanthasamy

²Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States
Sarah Coughlin

⁵Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Livia Archibugi

⁶Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
Nikhil Thiruvengadam

⁵Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Christopher Moreau

⁷Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, United States
David Jin

⁸Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Pedram Paragomi

⁹Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Francisco Valverde-López

¹⁰Division of Gastroenterology, Hospital Universitario Virgen de las Nieves, Granada, Spain
Sajan Nagpal

¹¹Division of Gastroenterology, Hepatology, and Nutrition. University of Chicago, Chicago, Illinois, United States
Cemal Yazici

¹²Division of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, Illinois, United States
Georgios Papachristou

¹Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
Peter J Lee

⁵Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Venkata Akshintala

²Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States

on behalf of the Collaborative Alliance for Pancreatic Education and Research (CAPER)

Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided tissue sampling is the standard of care for diagnosing solid pancreatic lesions. While many two-way comparisons between needle types have been made in randomized controlled trials (RCTs), it is unclear which size and type of needle offers the best probability of diagnosis. We therefore performed a network meta-analysis (NMA) to compare different sized and shaped needles to rank the diagnostic performance of each needle.

Methods We searched MEDLINE, EMBASE and Cochrane Library databases through August, 2020 for RCTs that compared the diagnostic accuracy of EUS fine-needle aspiration (FNA) and biopsy (FNB) needles in solid pancreatic masses. Using a random-effects NMA under the frequentist framework, RCTs were analyzed to identify the best needle type and sampling technique. Performance scores (P-scores) were used to rank the different needles based on pooled diagnostic accuracy. The NMA model was used to calculate pairwise relative risk (RR) with 95 % confidence intervals.

Results Review of 2577 studies yielded 29 RCTs for quantitative synthesis, comparing 13 different needle types. All 22G FNB needles had an RR > 1 compared to the reference 22G FNA (Cook) needle. The highest P-scores were seen with the 22G Medtronic FNB needle (0.9279), followed by the 22G Olympus FNB needle (0.8962) and the 22G Boston Scientific FNB needle (0.8739). Diagnostic accuracy was not significantly different between needles with or without suction.

Conclusions In comparison to FNA needles, FNB needles offer the highest diagnostic performance in sampling pancreatic masses, particularly with 22G FNB needles.

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Referenzen

References
1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7-30
2 Haghighi M, Packey C, Gonda TA. Endoscopic ultrasonography with fine-needle aspiration: new techniques for interpretation of endoscopic ultrasonography cytology and histology specimens. Gastrointest Endosc Clin North Am 2017; 27: 601-614
3 Dumonceau JM, Deprez PH, Jenssen C. et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017. Endoscopy 2017; 49: 695-714
4 James TW, Baron TH. A comprehensive review of endoscopic ultrasound core biopsy needles. Expert Rev Med Dev 2018; 15: 127-135
5 Polkowski M, Jenssen C, Kaye P. et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy 2017; 49: 989-1006
6 Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy 2016; 48: 339-349
7 Oh HC, Kang H, Lee JY. et al. Diagnostic accuracy of 22/25-gauge core needle in endoscopic ultrasound-guided sampling: systematic review and meta-analysis. The Korean J Internal Med 2016; 31: 1073-1083
8 Facciorusso A, Wani S, Triantafyllou K. et al. Comparative accuracy of needle sizes and designs for EUS tissue sampling of solid pancreatic masses: a network meta-analysis. Gastrointest Endosc 2019; 90: 893-903.e897
9 Xu MM, Jia HY, Yan LL. et al. Comparison of two different size needles in endoscopic ultrasound-guided fine-needle aspiration for diagnosing solid pancreatic lesions: A meta-analysis of prospective controlled trials. Medicine 2017; 96: e5802
10 Facciorusso A, Stasi E, Di Maso M. et al. Endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions with 22 versus 25 Gauge needles: A meta-analysis. United Europ Gastroenterol J 2017; 5: 846-853
11 Madhoun MF, Wani SB, Rastogi A. et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis. Endoscopy 2013; 45: 86-92
12 Jorgensen J, Kubiliun N, Law JK. et al. Endoscopic retrograde cholangiopancreatography (ERCP): core curriculum. Gastrointest Endosc 2016; 83: 279-289
13 Facciorusso A, Bajwa HS, Menon K. et al. Comparison between 22G aspiration and 22G biopsy needles for EUS-guided sampling of pancreatic lesions: A meta-analysis. Endosc Ultrasound 2020; 9: 167-174
14 Tian G, Bao H, Li J. et al. Systematic review and meta-analysis of diagnostic accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) Using 22-gauge and 25-gauge needles for pancreatic masses. Med Sci Monitor 2018; 24: 8333-8341
15 Rosenthal LS. Is a fourth year of training necessary to become competent in EUS and ERCP? Notes from the 2008 class of advanced endoscopy fellows. Gastrointestinal endoscopy 2008; 68: 1150-1152
16 [Anonymous]. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008
17 Forbes N, Mohamed R, Raman M. Learning curve for endoscopy training: Is it all about numbers?. Best practice & research Clinical gastroenterology 2016; 30: 349-356
18 Rucker G. Network meta-analysis, electrical networks and graph theory. Res Synth Methods 2012; 3: 312-324
19 Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 2011; 64: 163-171
20 Mbuagbaw L, Rochwerg B, Jaeschke R. et al. Approaches to interpreting and choosing the best treatments in network meta-analyses. Syst Rev 2017; 6: 79
21 Rucker G, Schwarzer G. Resolve conflicting rankings of outcomes in network meta-analysis: Partial ordering of treatments. Res Synth Methods 2017; 8: 526-536
22 Cochran WG. The comparison of percentages in matched samples. Biometrika 1950; 37: 256-266
23 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
24 Chaimani A, Salanti G. Using network meta-analysis to evaluate the existence of small-study effects in a network of interventions. Res Synth Methods 2012; 3: 161-176
25 Salanti G, Del Giovane C, Chaimani A. et al. Evaluating the quality of evidence from a network meta-analysis. PLoS One 2014; 9: e99682
26 Brignardello-Petersen R, Murad MH, Walter SD. et al. GRADE approach to rate the certainty from a network meta-analysis: avoiding spurious judgments of imprecision in sparse networks. J Clin Epidemiol 2019; 105: 60-67
27 Aadam AA, Wani S, Amick A. et al. A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy. Endosc Int Open 2016; 4: E497-E505
28 Alatawi A, Beuvon F, Grabar S. et al. Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions. United Europ Gastroenterol J 2015; 3: 343-352
29 Asokkumar R, Yung Ka C, Loh T. et al. Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a randomized study. Endosc Int Open 2019; 7: E955-E963
30 Cheng B, Zhang Y, Chen Q. et al. Analysis of fine-needle biopsy vs fine-needle aspiration in diagnosis of pancreatic and abdominal masses: a prospective, multicenter, randomized controlled trial. Clin Gastroenterol Hepatol 2018; 16: 1314-1321
31 Fabbri C, Polifemo AM, Luigiano C. et al. Endoscopic ultrasound-guided fine needle aspiration with 22- and 25-gauge needles in solid pancreatic masses: a prospective comparative study with randomisation of needle sequence. Digest Liver Dis 2011; 43: 647-652
32 Gimeno-Garcia AZ, Elwassief A, Paquin SC. et al. Randomized controlled trial comparing stylet-free endoscopic ultrasound-guided fine-needle aspiration with 22-G and 25-G needles. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society 2014; 26: 467-473
33 Hucl T, Wee E, Anuradha S. et al. Feasibility and efficiency of a new 22G core needle: a prospective comparison study. Endoscopy 2013; 45: 792-798
34 Laquiere A, Lefort C, Maire F. et al. 19 G nitinol needle versus 22 G needle for transduodenal endoscopic ultrasound-guided sampling of pancreatic solid masses: a randomized study. Endoscopy 2019; 51: 436-443
35 Lee JH, Stewart J, Ross WA. et al. Blinded prospective comparison of the performance of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of the pancreas and peri-pancreatic lesions. Digest Dis Sci 2009; 54: 2274-2281
36 Lee JK, Choi ER, Jang TH. et al. A prospective comparison of liquid-based cytology and traditional smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration. Acta Cytologica 2011; 55: 401-407
37 Lee JK, Choi JH, Lee KH. et al. A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses. Gastrointest Endosc 2013; 77: 745-751
38 Lee JK, Lee KT, Choi ER. et al. A prospective, randomized trial comparing 25-gauge and 22-gauge needles for endoscopic ultrasound-guided fine needle aspiration of pancreatic masses. Scand J Gastroenterol 2013; 48: 752-757
39 Lee YN, Moon JH, Kim HK. et al. Core biopsy needle versus standard aspiration needle for endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized parallel-group study. Endoscopy 2014; 46: 1056-1062
40 Lee BS, Cho CM, Jung MK. et al. Comparison of histologic core portions acquired from a core biopsy needle and a conventional needle in solid mass lesions: a prospective randomized trial. Gut Liver 2017; 11: 559-566
41 Mavrogenis G, Weynand B, Sibille A. et al. 25-gauge histology needle versus 22-gauge cytology needle in endoscopic ultrasonography-guided sampling of pancreatic lesions and lymphadenopathy. Endosc Int Open 2015; 3: E63-E68
42 Mohamadnejad M, Mullady D, Early DS. et al. Increasing number of passes beyond 4 does not increase sensitivity of detection of pancreatic malignancy by endoscopic ultrasound-guided fine-needle aspiration. Clin Gastroenterol Hepatol 2017; 15: 1071-1078.e1072
43 Mukai S, Itoi T, Ashida R. et al. Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos). Gastrointest Endosc 2016; 83: 1210-1217
44 Sakamoto H, Kitano M, Komaki T. et al. Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol 2009; 24: 384-390
45 Sterlacci W, Sioulas AD, Veits L. et al. 22-gauge core vs 22-gauge aspiration needle for endoscopic ultrasound-guided sampling of abdominal masses. World J Gastroenterol 2016; 22: 8820-8830
46 Vanbiervliet G, Napoleon B, Saint Paul MC. et al. Core needle versus standard needle for endoscopic ultrasound-guided biopsy of solid pancreatic masses: a randomized crossover study. Endoscopy 2014; 46: 1063-1070
47 Wani S, Mullady D, Early DS. et al. The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: a prospective multicenter randomized controlled trial. Am J Gastroenterol 2015; 110: 1429-1439
48 Song TJ, Kim JH, Lee SS. et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol 2010; 105: 1739-1745
49 Bang JY, Krall K, Jhala N. et al. Comparing needles and methods of endoscopic ultrasound-guided fine-needle biopsy to optimize specimen quality and diagnostic accuracy for patients with pancreatic masses in a randomized trial. Clin Gastroenterol Hepatol 2020; S1542-3565(20): 30905-30908
50 Karsenti D, Palazzo L, Perrot B. et al. 22G Acquire vs. 20G Procore needle for endoscopic ultrasound-guided biopsy of pancreatic masses: a randomized study comparing histologic sample quantity and diagnostic accuracy. Endoscopy 2020;
51 Bang JY, Hebert-Magee S, Navaneethan U. et al. Randomized trial comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy sampling of solid pancreatic mass lesions. Gastrointest Endosc 2018; 87: 1432-1438
52 Bang JY, Magee SH, Ramesh J. et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-450
53 Hedenstrom P, Demir A, Khodakaram K. et al. EUS-guided reverse bevel fine-needle biopsy sampling and open tip fine-needle aspiration in solid pancreatic lesions - a prospective, comparative study. Scand J Gastroenterol 2018; 53: 231-237
54 Ramesh J, Bang JY, Hebert-Magee S. et al. Randomized Trial comparing the flexible 19g and 25g needles for endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass lesions. Pancreas 2015; 44: 128-133
55 Saxena P, El Zein M, Stevens T. et al. Stylet slow-pull versus standard suction for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic lesions: a multicenter randomized trial. Endoscopy 2018; 50: 497-504
56 Tarantino I, Di Mitri R, Fabbri C. et al. Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. Digest Liver Dis 2014; 46: 523-526
57 Ishiwatari H, Hayashi T, Kawakami H. et al. Randomized trial comparing a side-port needle and standard needle for EUS-guided histology of pancreatic lesions. Gastrointest Endosc 2016; 84: 670-678
58 Noh DH, Choi K, Gu S. et al. Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial. Scand J Gastroenterol 2018; 53: 94-99
59 Tian L, Tang AL, Zhang L. et al. Evaluation of 22G fine-needle aspiration (FNA) versus fine-needle biopsy (FNB) for endoscopic ultrasound-guided sampling of pancreatic lesions: a prospective comparison study. Surg Endosc 2018; 32: 3533-3539
60 Kudo T, Kawakami H, Hayashi T. et al. High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2014; 80: 1030-1037.e1031
61 Igarashi R, Irisawa A, Bhutani MS. et al. The feasibility and histological diagnostic accuracy of novel menghini needle (EUS Sonopsy CY™) for endoscopic ultrasound-guided fine-needle aspiration biopsy of solid pancreatic masses: a prospective crossover study comparing standard biopsy needles. Gastroenterol Res Pract 2019; 2019: 5810653
62 Cho E, Park CH, Kim TH. et al. A prospective, randomized, multicenter clinical trial comparing 25-gauge and 20-gauge biopsy needles for endoscopic ultrasound-guided sampling of solid pancreatic lesions. Surg Endosc 2020; 34: 1310-1317
63 Park SW, Chung MJ, Lee SH. et al. Prospective study for comparison of endoscopic ultrasound-guided tissue acquisition using 25- and 22-gauge core biopsy needles in solid pancreatic masses. PloS one 2016; 11: e0154401
64 Woo YS, Lee KH, Noh DH. et al. 22G versus 25G biopsy needles for EUS-guided tissue sampling of solid pancreatic masses: a randomized controlled study. Scand J Gastroenterol 2017; 52: 1435-1441
65 Bang JY, Kirtane S, Krall K. et al. In memoriam: Fine-needle aspiration, birth: Fine-needle biopsy: The changing trend in endoscopic ultrasound-guided tissue acquisition. Dig Endosc 2019; 31: 197-202
66 Domagk D, Oppong KW, Aabakken L. et al. Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterol J 2018; 6: 1448-1460
67 Wani S, Wallace MB, Cohen J. et al. Quality indicators for EUS. Gastrointest Endosc 2015; 81: 67-80
68 Kamata K, Kitano M, Yasukawa S. et al. Histologic diagnosis of pancreatic masses using 25-gauge endoscopic ultrasound needles with and without a core trap: a multicenter randomized trial. Endoscopy 2016; 48: 632-638

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