Skip to main content
Top
Published in: BMC Gastroenterology 1/2016

Open Access 01-12-2016 | Research article

Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies

Authors: Omar Banafea, Fabian Pius Mghanga, Jinfang Zhao, Ruifeng Zhao, Liangru Zhu

Published in: BMC Gastroenterology | Issue 1/2016

Login to get access

Abstract

Background

Previous studies have demonstrated that endoscopic ultrasound-fine needle aspiration (EUS-FNA) is a reliable tool for diagnosing pancreatic lesions; however, the reported sensitivity and specificity vary greatly across studies. The aim of this study was to pool the existing literature and assess the overall performance of EUS-FNA in the diagnosis of solid pancreatic lesions.

Methods

A systematic search of MEDLINE, Cochrane Database for Systematic Reviews, and EMBASE was performed to identify original and review articles published between January 1995 and January 2014 that reported the accuracy of EUS-FNA in the diagnosis of pancreatic masses. Quality of the included studies was assessed using the quality assessment of diagnosis accuracy studies score tool. Meta-DiSc software was used to calculate the pooled sensitivity and specificity, positive and negative likelihood ratios, and to construct the summary receiver operating characteristics curve.

Results

Twenty studies involving a total of 2,761 patients were included in the study. The pooled sensitivity and specificity of EUS-FNA in the diagnosis of solid pancreatic lesions were 90.8 % [95 % confidence interval (CI), 89.4–92 %] and 96.5 % (95 % CI, 94.8–97.7 %), respectively. The positive and negative likelihood ratios were 14.8 (95 % CI, 8.0–27.3) and 0.12 (95 % CI, 0.09–0.16), respectively. The overall diagnostic accuracy was 91.0 %.

Conclusions

Our findings suggest that EUS-FNA has high sensitivity and specificity in the diagnosis of solid pancreatic lesions.
Literature
1.
go back to reference Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55(1):10–30.CrossRefPubMed Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55(1):10–30.CrossRefPubMed
5.
go back to reference Podolsky DK, McPhee MS, Alpert E, Warshaw AL, Isselbacher KJ. Galactosyltransferase isoenzyme II in the detection of pancreatic cancer: comparison with radiologic, endoscopic, and serologic tests. N Engl J Med. 1981;304(22):1313–8. doi:10.1056/nejm198105283042201.CrossRefPubMed Podolsky DK, McPhee MS, Alpert E, Warshaw AL, Isselbacher KJ. Galactosyltransferase isoenzyme II in the detection of pancreatic cancer: comparison with radiologic, endoscopic, and serologic tests. N Engl J Med. 1981;304(22):1313–8. doi:10.​1056/​nejm198105283042​201.CrossRefPubMed
10.
go back to reference Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, van Velse A, Osborne JF, et al. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy. 1997;29(9):854–8. doi:10.1055/s-2007-1004321.CrossRefPubMed Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, van Velse A, Osborne JF, et al. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy. 1997;29(9):854–8. doi:10.​1055/​s-2007-1004321.CrossRefPubMed
11.
go back to reference Faigel DO, Ginsberg GG, Bentz JS, Gupta PK, Smith DB, Kochman ML. Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. J Clin Oncol. 1997;15(4):1439–43.PubMed Faigel DO, Ginsberg GG, Bentz JS, Gupta PK, Smith DB, Kochman ML. Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. J Clin Oncol. 1997;15(4):1439–43.PubMed
12.
go back to reference Voss M, Hammel P, Molas G, Palazzo L, Dancour A, O’Toole D, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut. 2000;46(2):244–9.CrossRefPubMedPubMedCentral Voss M, Hammel P, Molas G, Palazzo L, Dancour A, O’Toole D, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut. 2000;46(2):244–9.CrossRefPubMedPubMedCentral
13.
go back to reference Gress F, Gottlieb K, Sherman S, Lehman G. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med. 2001;134(6):459–64.CrossRefPubMed Gress F, Gottlieb K, Sherman S, Lehman G. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med. 2001;134(6):459–64.CrossRefPubMed
14.
go back to reference Ylagan LR, Edmundowicz S, Kasal K, Walsh D, Lu DW. Endoscopic ultrasound guided fine-needle aspiration cytology of pancreatic carcinoma: a 3-year experience and review of the literature. Cancer. 2002;96(6):362–9. doi:10.1002/cncr.10759.CrossRefPubMed Ylagan LR, Edmundowicz S, Kasal K, Walsh D, Lu DW. Endoscopic ultrasound guided fine-needle aspiration cytology of pancreatic carcinoma: a 3-year experience and review of the literature. Cancer. 2002;96(6):362–9. doi:10.​1002/​cncr.​10759.CrossRefPubMed
16.
go back to reference Raut CP, Grau AM, Staerkel GA, Kaw M, Tamm EP, Wolff RA, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg. 2003;7(1):118–26. discussion 27-8.CrossRefPubMed Raut CP, Grau AM, Staerkel GA, Kaw M, Tamm EP, Wolff RA, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg. 2003;7(1):118–26. discussion 27-8.CrossRefPubMed
17.
go back to reference Afify AM, al-Khafaji BM, Kim B, Scheiman JM. Endoscopic ultrasound-guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy. Acta Cytol. 2003;47(3):341–8.CrossRefPubMed Afify AM, al-Khafaji BM, Kim B, Scheiman JM. Endoscopic ultrasound-guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy. Acta Cytol. 2003;47(3):341–8.CrossRefPubMed
19.
go back to reference Ryozawa S, Kitoh H, Gondo T, Urayama N, Yamashita H, Ozawa H, et al. Usefulness of endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of pancreatic cancer. J Gastroenterol. 2005;40(9):907–11. doi:10.1007/s00535-005-1652-6.CrossRefPubMed Ryozawa S, Kitoh H, Gondo T, Urayama N, Yamashita H, Ozawa H, et al. Usefulness of endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of pancreatic cancer. J Gastroenterol. 2005;40(9):907–11. doi:10.​1007/​s00535-005-1652-6.CrossRefPubMed
20.
go back to reference Eloubeidi MA, Varadarajulu S, Desai S, Shirley R, Heslin MJ, Mehra M, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11(7):813–9. doi:10.1007/s11605-007-0151-x.CrossRefPubMed Eloubeidi MA, Varadarajulu S, Desai S, Shirley R, Heslin MJ, Mehra M, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11(7):813–9. doi:10.​1007/​s11605-007-0151-x.CrossRefPubMed
21.
go back to reference Krishna NB, Mehra M, Reddy AV, Agarwal B. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc. 2009;70(1):70–9. doi:10.1016/j.gie.2008.10.030.CrossRefPubMed Krishna NB, Mehra M, Reddy AV, Agarwal B. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc. 2009;70(1):70–9. doi:10.​1016/​j.​gie.​2008.​10.​030.CrossRefPubMed
22.
go back to reference Touchefeu Y, Le Rhun M, Coron E, Alamdari A, Heymann MF, Mosnier JF, et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy. Aliment Pharmacol Ther. 2009;30(10):1070–7. doi:10.1111/j.1365-2036.2009.04138.x.CrossRefPubMed Touchefeu Y, Le Rhun M, Coron E, Alamdari A, Heymann MF, Mosnier JF, et al. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy. Aliment Pharmacol Ther. 2009;30(10):1070–7. doi:10.​1111/​j.​1365-2036.​2009.​04138.​x.CrossRefPubMed
23.
go back to reference Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997;45(5):387–93.CrossRefPubMed Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997;45(5):387–93.CrossRefPubMed
24.
go back to reference Bentz JS, Kochman ML, Faigel DO, Ginsberg GG, Smith DB, Gupta PK. Endoscopic ultrasound-guided real-time fine-needle aspiration: clinicopathologic features of 60 patients. Diagn Cytopathol. 1998;18(2):98–109.CrossRefPubMed Bentz JS, Kochman ML, Faigel DO, Ginsberg GG, Smith DB, Gupta PK. Endoscopic ultrasound-guided real-time fine-needle aspiration: clinicopathologic features of 60 patients. Diagn Cytopathol. 1998;18(2):98–109.CrossRefPubMed
26.
go back to reference Uehara H, Ikezawa K, Kawada N, Fukutake N, Katayama K, Takakura R, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic malignancy in relation to the size of lesions. J Gastroenterol Hepatol. 2011;26(8):1256–61. doi:10.1111/j.1440-1746.2011.06747.x.CrossRefPubMed Uehara H, Ikezawa K, Kawada N, Fukutake N, Katayama K, Takakura R, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic malignancy in relation to the size of lesions. J Gastroenterol Hepatol. 2011;26(8):1256–61. doi:10.​1111/​j.​1440-1746.​2011.​06747.​x.CrossRefPubMed
29.
go back to reference Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997;112(4):1087–95.CrossRefPubMed Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997;112(4):1087–95.CrossRefPubMed
30.
go back to reference Harewood GC, Wiersema LM, Halling AC, Keeney GL, Salamao DR, Wiersema MJ. Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses. Gastrointest Endosc. 2002;55(6):669–73.CrossRefPubMed Harewood GC, Wiersema LM, Halling AC, Keeney GL, Salamao DR, Wiersema MJ. Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses. Gastrointest Endosc. 2002;55(6):669–73.CrossRefPubMed
32.
go back to reference Itoi T, Itokawa F, Sofuni A, Nakamura K, Tsuchida A, Yamao K, et al. Puncture of solid pancreatic tumors guided by endoscopic ultrasonography: a pilot study series comparing Trucut and 19-gauge and 22-gauge aspiration needles. Endoscopy. 2005;37(4):362–6. doi:10.1055/s-2004-826156.CrossRefPubMed Itoi T, Itokawa F, Sofuni A, Nakamura K, Tsuchida A, Yamao K, et al. Puncture of solid pancreatic tumors guided by endoscopic ultrasonography: a pilot study series comparing Trucut and 19-gauge and 22-gauge aspiration needles. Endoscopy. 2005;37(4):362–6. doi:10.​1055/​s-2004-826156.CrossRefPubMed
34.
go back to reference Larghi A, Verna EC, Stavropoulos SN, Rotterdam H, Lightdale CJ, Stevens PD. EUS-guided trucut needle biopsies in patients with solid pancreatic masses: a prospective study. Gastrointest Endosc. 2004;59(2):185–90.CrossRefPubMed Larghi A, Verna EC, Stavropoulos SN, Rotterdam H, Lightdale CJ, Stevens PD. EUS-guided trucut needle biopsies in patients with solid pancreatic masses: a prospective study. Gastrointest Endosc. 2004;59(2):185–90.CrossRefPubMed
35.
go back to reference Varadarajulu S, Fraig M, Schmulewitz N, Roberts S, Wildi S, Hawes RH, et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy. 2004;36(5):397–401. doi:10.1055/s-2004-814316.CrossRefPubMed Varadarajulu S, Fraig M, Schmulewitz N, Roberts S, Wildi S, Hawes RH, et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy. 2004;36(5):397–401. doi:10.​1055/​s-2004-814316.CrossRefPubMed
36.
go back to reference LeBlanc JK, Ciaccia D, Al-Assi MT, McGrath K, Imperiale T, Tao LC, et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc. 2004;59(4):475–81.CrossRefPubMed LeBlanc JK, Ciaccia D, Al-Assi MT, McGrath K, Imperiale T, Tao LC, et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc. 2004;59(4):475–81.CrossRefPubMed
37.
go back to reference Hikichi T, Irisawa A, Bhutani MS, Takagi T, Shibukawa G, Yamamoto G, et al. Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol. 2009;44(4):322–8. doi:10.1007/s00535-009-0001-6.CrossRefPubMed Hikichi T, Irisawa A, Bhutani MS, Takagi T, Shibukawa G, Yamamoto G, et al. Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol. 2009;44(4):322–8. doi:10.​1007/​s00535-009-0001-6.CrossRefPubMed
38.
go back to reference Mallery JS, Centeno BA, Hahn PF, Chang Y, Warshaw AL, Brugge WR. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc. 2002;56(2):218–24.CrossRefPubMed Mallery JS, Centeno BA, Hahn PF, Chang Y, Warshaw AL, Brugge WR. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc. 2002;56(2):218–24.CrossRefPubMed
39.
go back to reference Iwashita T, Yasuda I, Doi S, Nakashima M, Tsurumi H, Hirose Y, et al. Endoscopic ultrasound-guided fine-needle aspiration in patients with lymphadenopathy suspected of recurrent malignancy after curative treatment. J Gastroenterol. 2009;44(3):190–6. doi:10.1007/s00535-008-2302-6.CrossRefPubMed Iwashita T, Yasuda I, Doi S, Nakashima M, Tsurumi H, Hirose Y, et al. Endoscopic ultrasound-guided fine-needle aspiration in patients with lymphadenopathy suspected of recurrent malignancy after curative treatment. J Gastroenterol. 2009;44(3):190–6. doi:10.​1007/​s00535-008-2302-6.CrossRefPubMed
Metadata
Title
Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies
Authors
Omar Banafea
Fabian Pius Mghanga
Jinfang Zhao
Ruifeng Zhao
Liangru Zhu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2016
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-016-0519-z

Other articles of this Issue 1/2016

BMC Gastroenterology 1/2016 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine