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

Area of Science:

• Gastroenterology
• Oncology
• Medical Devices

Background:

• Endoscopic ultrasound (EUS)-guided tissue sampling is crucial for diagnosing solid pancreatic lesions.
• Existing randomized controlled trials (RCTs) offer limited comparative data on needle performance for EUS-guided tissue sampling.
• A comprehensive analysis is needed to rank the diagnostic efficacy of various needle types and sizes.

Purpose of the Study:

• To conduct a network meta-analysis (NMA) comparing different EUS-guided tissue sampling needles.
• To rank the diagnostic performance of various fine-needle aspiration (FNA) and fine-needle biopsy (FNB) needles for solid pancreatic masses.
• To identify the optimal needle type and size for maximizing diagnostic yield.

Main Methods:

• Systematic search of MEDLINE, EMBASE, and Cochrane Library databases for RCTs up to August 2020.
• Inclusion of RCTs comparing diagnostic accuracy of EUS FNA and FNB needles in solid pancreatic masses.
• Application of a random-effects NMA model to pool diagnostic accuracy and calculate relative risks (RR).

Main Results:

• Analysis of 29 RCTs involving 13 different needle types.
• All 22-gauge FNB needles demonstrated superior diagnostic performance (RR > 1) compared to the reference 22-gauge FNA needle.
• The 22-gauge Medtronic FNB needle achieved the highest diagnostic accuracy, followed by 22-gauge Olympus and Boston Scientific FNB needles.

Conclusions:

• EUS-guided FNB needles provide superior diagnostic performance for pancreatic masses over FNA needles.
• 22-gauge FNB needles are particularly effective for optimizing diagnostic yield in pancreatic mass sampling.
• Needle design and gauge size are critical factors influencing diagnostic accuracy in EUS-guided tissue acquisition.