Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis
Published on Apr 1, 2021in Endoscopy7.341
· DOI :10.1055/A-1206-5552
BACKGROUND EUS-guided tissue acquisition is extensively used, but the optimal sampling device is still a matter of debate. We performed a meta-analysis on studies comparing FNA to FNB needles, in addition to a mutual comparison of FNB needles. METHODS Online databases were searched for randomized controlled studies of at least 50 cases with a suspected solid pancreatic or non-pancreatic lesion that compared FNA to FNB ProCore, SharkCore, or Acquire needles. Outcome measures included diagnostic accuracy, adequacy, number of passes, presence of tissue cores, and adverse events. In addition, we performed a meta-regression analysis on the effect of FNB design on diagnostic accuracy. Quality was assessed using the QUADAS-2 tool. RESULTS 18 RCTs comparing FNA to FNB cases were included, all involving ProCore FNB needles. FNB provided a higher pooled diagnostic accuracy (87% vs 80%, p=0.02) and tissue core rate (77% vs 57%, p=0.01), and allowed a diagnosis within less passes (p=0.03). This was true for pancreatic and non-pancreatic lesions. 93 studies were included to compare the FNB devices. Pooled diagnostic accuracy was higher for SharkCore, Acquire and the ProCore forward facing bevel needles than for the ProCore reverse bevel needle. In this analysis, study quality was low and heterogeneity high (I2=80%). CONCLUSION FNB ProCore outperformed FNA when sampling pancreatic and non-pancreatic lesions. SharkCore, Acquire and ProCore forward facing bevel FNB needles seem to outperform the ProCore reverse bevel needle, but the low quality of evidence prevents us from making strong recommendations on the optimal FNB design.