Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: a meta-analysis.

Abstract

BACKGROUND AND AIMS\nThere is limited evidence on the diagnostic performance of endoscopic ultrasound-guided fine-needle biopsy in patients with subepithelial lesions. Aim of this meta-analysis was to compare EUS-guided fine-needle biopsy performance to fine-needle aspiration in patients with GI subepithelial lesions.\n\n\nMETHODS\nComputerized bibliographic search on the main databases was performed through May 2019. Primary endpoint was sample adequacy. Secondary outcomes were diagnostic accuracy, histological core procurement rate, and mean number of needle passes. Summary estimates were expressed in terms of odds ratio and 95% confidence interval.\n\n\nRESULTS\nTen studies (including 6 randomized trials) with 669 patients were included. Pooled rates of adequate samples were 94.9% (92.3%-97.5%) and 80.6% (71.4%-89.7%) with fine-needle biopsy and aspiration, respectively (odds ratio, 2.54; 95% CI, 1.29-5.01; p=0.007). When rapid on-site evaluation was available, no significant difference between the two techniques was observed. Optimal histologic core procurement rate was 89.7% (84.5%-94.9%) with fine-needle biopsy and 65% (55.5%-74.6%) with fine-needle aspiration (odds ratio, 3.27; 95% CI, 2.03-5.27; p<0.0001). Diagnostic accuracy was significantly superior in patients undergoing fine-needle biopsy (odds ratio, 4.10; 95% CI, 2.48-6.79; p<0.0001) with the need of a lower number of passes (mean difference: -0.75, -1.20 to -0.30; p=0.001). Sensitivity analysis confirmed these findings in all of the subgroups tested. Very few adverse events were observed and did not impact on patient outcomes.\n\n\nCONCLUSION\nOur results speak clearly in favor of fine-needle biopsy, which was found to outperform fine-needle aspiration in all of the diagnostic outcomes evaluated.