Comparative accuracy of needle sizes and designs for EUS tissue sampling of solid pancreatic masses: a network meta-analysis.
Abstract Background and Aims Variable diagnostic performance of sampling techniques during EUS-guided tissue acquisition of solid pancreatic masses based on needle type [fine-needle aspiration (FNA) versus fine-needle biopsy (FNB)] and gauge (19-gauge vs 22-gauge vs 25-gauge) has been reported. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of EUS-guided techniques for sampling solid pancreatic masses. Methods Through a systematic literature review till November 2018, we identified 27 RCTs (2711 patients) in adults undergoing EUS-guided sampling of solid pancreatic masses that evaluated the diagnostic performance of FNA and FNB needles based on needle gauge. Primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, histological core procurement rate, and number of needle passes. We performed pairwise and network meta-analyses, and appraised quality of evidence using GRADE methodology. Results On network meta-analysis, no specific EUS-guided tissue sampling technique was superior to others, based either on needle type (FNA vs FNB) or gauge (19-gauge vs 22-gauge vs 25-gauge) (low-quality evidence). Specifically, there was no difference between 25-gauge FNA versus 22-gauge FNA (RR, 1.03; 95% CI, 0.91-1.17) and 22-gauge FNB versus 22-gauge FNA (RR, 1.03; 95% CI, 0.89 -1.18) needle for diagnostic accuracy, sample adequacy, and histological core procurement. Findings were confirmed in sensitivity analysis restricted to studies with no use of rapid on-site cytologic evaluation and no use of fanning technique. Conclusion On network meta-analysis, no specific EUS-guided tissue sampling technique was superior to others in diagnostic accuracy, sample adequacy or histological procurement rate for solid pancreatic masses, with low confidence in estimates.