Dataset Information

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review.

ABSTRACT: Rapid on-site evaluation (ROSE) during endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic masses has been reported to be associated with improved adequacy and diagnostic yield. However, recent observational data on the impact of ROSE have reported conflicting results. A meta-analysis and systematic review was therefore conducted to evaluate the contribution of ROSE during EUS-FNA of pancreatic masses.A systematic search was conducted in MEDLINE/Pubmed and EMBASE databases for studies comparing the efficacy of ROSE between patients in two cohorts. Outcomes considered included diagnostic adequate rate, diagnostic yield, number of needle passes, pooled sensitivity and specificity. Findings from a random-effects model were expressed as pooled risk difference (RD) with 95% confidence intervals (CIs).A total of 7 studies (1299 patients) was finally included and further analyzed in the current meta-analysis. EUS-FNA with ROSE could not improve diagnostic adequacy (RD = 0.05, 95% CI: -0.01-0.11) and diagnostic yield (RD = 0.04 95%CI: -0.05, 0.13). The number of needle passes showed no statistically significant difference with and without ROSE (RD = -0.68 95%CI: -2.35, 0.98). The pooled sensitivity and specificity of ROSE group were 0.91 (95%CI: 0.87, 0.94) and 1 (95%CI: 0.94, 1.00). The pooled sensitivity and specificity of non-ROSE group were 0.85 (95%CI: 0.80, 0.89) and 1 (95%CI: 0.95, 1.00). ROSE group and non-ROSE group showed comparable sensitivity and specificity.Compared to historical reports of its clinical efficacy in patients with pancreatic lesions, ROSE may be not associated with an improvement of diagnostic yield, adequate rate, pooled sensitivity and specificity.

SUBMITTER: Kong F

PROVIDER: S-EPMC5033338 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review.

Kong Fanyang F Zhu Jianwei J Kong Xiangyu X Sun Tao T Deng Xuan X Du Yiqi Y Li Zhaoshen Z

PloS one 20160922 9

<h4>Background and objectives</h4>Rapid on-site evaluation (ROSE) during endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic masses has been reported to be associated with improved adequacy and diagnostic yield. However, recent observational data on the impact of ROSE have reported conflicting results. A meta-analysis and systematic review was therefore conducted to evaluate the contribution of ROSE during EUS-FNA of pancreatic masses.<h4>Method</h4>A systematic sear ...[more]

PMID: 27657529

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Project description:Background and study aims ?Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is traditionally considered a first-line strategy for diagnosing pancreatic lesions; however, given less than ideal accuracy rates, fine-needle biopsy (FNB) has been recently developed to yield histological tissue. The aim of this study was to compare diagnostic yield and safety between EUS-FNA and EUS-FNB in sampling of pancreatic masses. Patients and methods ?This was a multicenter retrospective study to evaluate efficacy and safety of EUS-FNA and EUS-FNB for pancreatic lesions. Baseline characteristics including sensitivity, specificity, and accuracy, were evaluated. Rapid on-site evaluation (ROSE) diagnostic adequacy, cell-block accuracy, and adverse events were analyzed. Subgroup analyses comparing FNA versus FNB route of tissue acquisition and comparison between methods with or without ROSE were performed. Multivariable logistic regression was also performed. Results ?A total of 574 patients (n?=?194 FNA, n?=?380 FNB) were included. Overall sensitivity, specificity, and accuracy of FNB versus FNA were similar [(89.09?% versus 85.62?%; P ?=?0.229), (98.04?% versus 96.88?%; P ?=?0.387), and 90.29?% versus 87.50?%; P ?=?0.307)]. Number of passes for ROSE adequacy and cell-block accuracy were comparable for FNA versus FNB [(3.06?±?1.62 versus 3.04?±?1.88; P ?=?0.11) and (3.08?±?1.63 versus 3.35?±?2.02; P ?=?0.137)]. FNA?+?ROSE was superior to FNA alone regarding sensitivity and accuracy [91.96?% versus 70.83?%; P ?<?0.001) and (91.80?% versus 80.28?%; P ?=?0.020)]. Sensitivity of FNB?+?ROSE and FNB alone were superior to FNA alone [(92.17?% versus 70.83?%; P ?<?0.001) and (87.44?% versus 70.83?%; P ?<?0.001)]. There was no difference in sensitivity though improved accuracy between FNA?+?ROSE versus FNB alone [(91.96?% versus 87.44?%; P ?=?0.193) and (91.80?% versus 80.72?%; P ?=?0.006)]. FNB?+?ROSE was more accurate than FNA?+?ROSE (93.13?% versus 91.80?% ; P ?=?0.001). Multivariate analysis showed ROSE was a significant predictor of accuracy [OR 2.60 (95?% CI, 1.41-4.79)]. One adverse event occurred after FNB resulting in patient death. Conclusion ?EUS-FNB allowed for more consistent cell-block evaluation as compared to EUS-FNA. EUS-FNA?+?ROSE was found to have a similar sensitivity to EUS-FNB alone suggesting a reduced need for ROSE as part of the standard algorithm of pancreatic sampling. While FNB alone produced similar diagnostic findings to EUS-FNA?+?ROSE, FNB?+?ROSE still was noted to increase diagnostic yield. This finding may favor a unique role for FNB?+?ROSE, suggesting it may be useful in cases when previous EUS-guided sampling may have been indeterminate.

Dataset Information

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review.

Publications

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review.

Similar Datasets

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