Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(05): E656-E667
DOI: 10.1055/a-1119-6543
Review

Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis

Donevan R. Westerveld
1   Department of Internal Medicine, University of Florida, Gainesville, Florida, United States
,
Sandeep A. Ponniah
1   Department of Internal Medicine, University of Florida, Gainesville, Florida, United States
,
Peter V. Draganov
2   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Dennis Yang
2   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Accurate diagnosis and risk stratification of pancreatic cysts (PCs) is challenging. The aim of this study was to perform a systematic review and meta-analysis to assess the feasibility, safety, and diagnostic yield of endoscopic ultrasound-guided through-the-needle biopsy (TTNB) versus fine-needle aspiration (FNA) in PCs.

Methods Comprehensive search of databases (PubMed, EMBASE, Cochrane, Web of Science) for relevant studies on TTNB of PCs (from inception to June 2019). The primary outcome was to compare the pooled diagnostic yield and concordance rate with surgical pathology of TTNB histology and FNA cytology of PCs. The secondary outcome was to estimate the safety profile of TTNB.
Results: Eight studies (426 patients) were included. The diagnostic yield was significantly higher with TTNB over FNA for a specific cyst type (OR: 9.4; 95 % CI: [5.7–15.4]; I2 = 48) or a mucinous cyst (MC) (OR: 3.9; 95 % CI: [2.0–7.4], I2 = 72 %). The concordance rate with surgical pathology was significantly higher with TTNB over FNA for a specific cyst type (OR: 13.5; 95 % CI: [3.5–52.3]; I2 = 48), for a MC (OR: 8.9; 95 % [CI: 1.9–40.8]; I2 = 29), and for MC histologic severity (OR: 10.4; 95 % CI: [2.9–36.9]; I2 = 0). The pooled sensitivity and specificity of TTNB for MCs were 90.1 % (95 % CI: [78.4–97.6]; I2 = 36.5 %) and 94 % (95 % CI: [81.5–99.7]; I2 = 0), respectively. The pooled adverse event rate was 7.0 % (95 % CI: [2.3–14.1]; I2 = 82.9).

Conclusions TTNB is safe, has a high sensitivity and specificity for MCs and may be superior to FNA cytology in risk-stratifying MCs and providing a specific cyst diagnosis.

Supplementary material



Publication History

Received: 22 October 2019

Accepted: 15 January 2020

Article published online:
17 April 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Lee KS, Sekhar A, Rofsky NM. et al. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 2010; 105: 2079-2084
    CrossrefPubMedGoogle Scholar
  • 2 Khashab MA, Kim K, Lennon AM. et al. Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/RMI for prediction of cystic neoplasms. Pancreas 2013; 42: 717-721
    CrossrefPubMedGoogle Scholar
  • 3 Visser BC, Yeh BM, Qayyum A. et al. Characterization of cystic pancreatic masses: relative accuracy of CT and MRI. AJR Am J Roentgenol 2008; 189: 648-656
    PubMedGoogle Scholar
  • 4 Alkaade S, Chahla E, Levy M. Role of endoscopic ultrasound-guided fine-needle aspiration, cytology, viscosity, and carcinoembryonic antigen in pancreatic cyst fluid. Endosc Ultrasound 2015; 4: 299-303
    CrossrefPubMedGoogle Scholar
  • 5 Brugge WR. The use of EUS to diagnose cystic neoplasms of the pancreas. Gastrointest Endosc 2009; 69: S203-S209
    CrossrefPubMedGoogle Scholar
  • 6 Brugge WR, Lewandrowski K, Lee-Lewandrowski E. et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126: 1330-1336
    CrossrefPubMedGoogle Scholar
  • 7 Vege SS, Ziring B, Jain R. et al. American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts. Gastroenterology 2015; 148: 819-822
    CrossrefPubMedGoogle Scholar
  • 8 Tanaka M, Fernandez-del-Castillo C, Kamisawa T. et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17: 738-753
    CrossrefPubMedGoogle Scholar
  • 9 Elta GH, Enestvedt BK, Sauer BG. et al. ACG Clinical Guideline: Diagnosis and Management of Pancreas Cysts. Am J Gastroenterol 2018; 113: 464-479
    CrossrefPubMedGoogle Scholar
  • 10 European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789-804
    CrossrefPubMedGoogle Scholar
  • 11 de Jong K, Poley JW, van Hooft JE. et al. Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study. Endoscopy 2011; 43: 585-590
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Attasaranya S, Pais S, LeBlanc J. et al. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP 2007; 8: 553-563
    PubMedGoogle Scholar
  • 13 Brugge WR, Lewandrowski K, Lee-Lewandrowski E. et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126: 1330-1336
    CrossrefPubMedGoogle Scholar
  • 14 Park WG, Mascarenhas R, Palaez-Luna M. et al. Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. Pancreas 2011; 40: 42-45
    CrossrefPubMedGoogle Scholar
  • 15 Gaddam S, Ge PS, Keach JW. et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc 2015; 82: 1060-1069
    CrossrefPubMedGoogle Scholar
  • 16 Samarasena JB, Nakai Y, Shinoura S. et al. EUS-guided, through-the-needle forceps biopsy: a novel tissue acquisition technique. Gastrointest Endosc 2015; 81: 225-226
    CrossrefPubMedGoogle Scholar
  • 17 Coman RM, Schlachterman A, Esnakula AK. et al. EUS-guided through-the-needle forceps: clenching down the diagnosis. Gastrointest Endosc 2016; 84: 372-373
    PubMedGoogle Scholar
  • 18 Attili F, Pagliari D, Rimbas M. et al. Endoscopic ultrasound-guided histological diagnosis of a mucinous non-neoplastic pancreatic cyst using a specially designed through-the-needle microforceps. Endoscopy 2016; 48: E188-E189
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Huelsen AX, Cooper CX, Saad NX. et al. Endoscopic ultrasound-guided, through-the-needle forceps biopsy in the assessment of an incidental large pancreatic cystic lesion with prior inconclusive fine-needle aspiration. Endoscopy 2017; 49: E109-E110
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Kovacevic B, Karstensen JG, Havre RF. et al. Initial experience with EUS-guided microbiopsy forceps in diagnosing pancreatic cystic lesions: A multicenter feasibility study (with video). Endosc Ultrasound 2018; 7: 383-388
    CrossrefPubMedGoogle Scholar
  • 21 Barresi L, Crino SF, Fabbri C. et al. Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A multicenter study. Dig Endosc 2018; 30: 760-770
    CrossrefPubMedGoogle Scholar
  • 22 Basar O, Yuksel O, Yang D. et al. Feasibility and safety of micro-forceps biopsy in the diagnosis of pancreatic cysts. Gastrointest Endosc 2018; 88: 79-86
    CrossrefPubMedGoogle Scholar
  • 23 Kovacevic B, Klausen P, Hasselby JP. A novel endoscopic ultrasound-guided through-the-needle microbiopsy procedure improves diagnosis of pancreatic cystic lesions. Endoscopy 2018; 50: 1105-1111
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Mittal C, Obuch JC, Hammad H. et al. Technical feasibility, diagnostic yield, and safety of microforceps biopsies during EUS evaluation of pancreatic cystic lesions (with video). Gastrointest Endosc 2018; 87: 1263-1269
    CrossrefPubMedGoogle Scholar
  • 25 Yang D, Samarasena JB, Jamil LH. et al. Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. Endosc Int Open 2018; 6: E1423-E1430
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Zhang ML, Arpin RN, Brugge WR. et al. Moray micro forceps biopsy improves the diagnosis of specific pancreatic cysts. Cancer Cytopathol 2018; 126: 414-420
    PubMedGoogle Scholar
  • 27 Yang D, Trindade AJ, Yachimski P. et al. Histologic analysis of endoscopic ultrasound- guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts. Clin Gastroenterol Hepatol 2019; 17: 1587-1596
    CrossrefPubMedGoogle Scholar
  • 28 Crino SF, Bernardoni L, Brozzi L. et al. Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy of pancreatic cystic lesions. Gastrointest Endosc 2019; 90: 933-943
    CrossrefPubMedGoogle Scholar
  • 29 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
    CrossrefPubMedGoogle Scholar
  • 30 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence – inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
    CrossrefPubMedGoogle Scholar
  • 31 Easterbrook PJ, Gopalan R, Berlin JA. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
    CrossrefPubMedGoogle Scholar
  • 32 Lau J, Ioannidis JP, Terrin N. et al. The case of the misleading funnel plot. BMJ 2006; 333: 597-600
    CrossrefPubMedGoogle Scholar
  • 33 Higgins JPT, Green S. Cochrane Handbook for Systematic Review of Interventions. Chichester, West Sussex; Hoboken NJ: John Wiley & Sons; 2011
    Google Scholar
  • 34 Lilo MT, VandenBussche CJ, Allison BD. et al. Serous cystadenoma of the pancreas: potentials and pitfalls of a preoperative cytopathologic diagnosis. Acta Cytol 2017; 61: 27-33
    CrossrefPubMedGoogle Scholar
  • 35 Belsey NA, Pitman MB, Lauwers GY. et al. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 2008; 114: 102-110
    CrossrefPubMedGoogle Scholar
  • 36 Pitman MB, Centeno BA, Genevay M. et al. Grading epithelial atypia in endoscopic ultrasound fine-needle aspiration of intraductal papillary mucinous neoplasms: an international observer concordance study. Cancer Cytopathol 2013; 121: 729-736
    PubMedGoogle Scholar