Abstract
Background
Several recent studies have investigated the utility of 19-, 22-, and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration (EUS–FNA) of pancreatic and peri-pancreatic tumors.
Aim
The objective of this study was to summarize data from these studies and estimate the effect of needle size on reported outcomes such as accuracy, adequacy, and complications.
Methods
Systematic review and meta-analysis comparing the effect of needle size (19, 22, and 25G) on diagnostic accuracy, adequacy, number of needle passes, and complications.
Results
25G appear to confer an advantage in adequacy rates relative to 22G needles (risk difference = 0.12 %, 95 % CI 0.01, 0.25). There was no significant difference in accuracy with an overall sensitivity and specificity for 22G being 0.78 (95 % CI 0.74–0.81) and 1.00 (95 % CI 0.98–1.00) and an overall sensitivity and specificity for 25G being 0.91 (95 % CI 0.87–0.94) and 1.00 (95 % CI 0.97–1.00). There was no difference in number of passes or complications between 25 and 22G. The limited data available regarding 19G needles do not show evidence of improved outcomes with these devices.
Conclusions
In the evaluation of pancreatic and peri-pancreatic lesions by EUS–FNA, 25G needles may confer an advantage in adequacy relative to 22G needles but confer no advantages with respect to accuracy, number of passes, or complications.
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References
Fabbri C, Polifemo AM, Luigiano C, et al. Endoscopic ultrasound-guided fine needle aspiration with 22- and 25-gauge needles in solid pancreatic masses: a prospective comparative study with randomisation of needle sequence. Dig Liver Dis. 2011;43:647–652.
Schmidt RL, Factor RE, Affolter KE, et al. Methods specification for diagnostic test accuracy studies in fine-needle aspiration cytology: a survey of reporting practice. Am J Clin Pathol. 2012;137:132–141.
Camellini L, Carlinfante G, Azzolini F, et al. A randomized clinical trial comparing 22G and 25G needles in endoscopic ultrasound-guided fine-needle aspiration of solid lesions. Endoscopy. 2011;43:709–715.
Yusuf TE, Ho S, Pavey DA, Michael H, Gress FG. Retrospective analysis of the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS–FNA) in pancreatic masses, using a 22-gauge or 25-gauge needle system: a multicenter experience. Endoscopy. 2009;41:445–448.
Siddiqui UD, Rossi F, Rosenthal LS, Padda MS, Murali-Dharan V, Aslanian HR. EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles. Gastrointest Endosc. 2009;70:1093–1097.
Song TJ, Kim JH, Lee SS, et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol. 2010;105:1739–1745.
Sakamoto H, Kitano M, Komaki T, et al. Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol. 2009;24:384–390.
Imazu H, Uchiyama Y, Kakutani H, et al. A prospective comparison of EUS-guided FNA using 25-gauge and 22-gauge needles. Gastroenterol Res Pract. 2009;2009:Article ID 546390.
Lee JH, Stewart J, Ross WA, Anandasabapathy S, Xiao L, Staerkel G. Blinded prospective comparison of the performance of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of the pancreas and peri-pancreatic lesions. Dig Dis Sci. 2009;54:2274–2281.
Othman MO, Raimondo M. Endoscopic ultrasound fine needle aspiration of pancreatic lesions: Is a smaller needle safer and better? Dig Liver Dis. 2011;43:587–588.
Gerke H. EUS-guided FNA: better samples with smaller needles? Gastrointest Endosc. 2009;70:1098–1100.
Siddiqui UD, Aslanian HR. For EUS-Guided FNA of solid pancreatic masses, bigger is not always better. Am J Gastroenterol. 2011;106:801–802.
Yoshinaga S, Suzuki H, Oda I, Saito Y. Role of endoscopic ultrasound-guided fine needle aspiration (EUS–FNA) for diagnosis of solid pancreatic masses. Dig Endosc. 2011;23:29–33.
Itoi T, Itokawa F, Sofuni A, 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;37:362–366.
Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM, Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy. Ann Intern Med. 2008;149:889–897.
Deeks JJ, Bossuyt P, Gatsonis C, eds. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0.0. The Cochrane Collaboration. 2009. http://srdta.cochrane.org/
Harbord RM, Whiting P. Metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata J.. 2009;9:211–229.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558.
Siddiqui AA, Lyles T, Avula H, Davila R. Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses in a veteran population: comparison of results with 22- and 25-gauge needles [letter to the editor]. Pancreas. 2010;39:685–686.
Kida M, Araki M, Miyazawa S, et al. Comparison of diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration with 22- and 25-gauge needles in the same patients. J Interv Gastroenterol. 2011;1:102–107.
Whiting PF, Rutjes AWS, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–536.
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Kajsa E. Affolter and Robert L. Schmidt contributed equally to this work.
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Affolter, K.E., Schmidt, R.L., Matynia, A.P. et al. Needle Size Has Only a Limited Effect on Outcomes in EUS-Guided Fine Needle Aspiration: A Systematic Review and Meta-Analysis. Dig Dis Sci 58, 1026–1034 (2013). https://doi.org/10.1007/s10620-012-2439-2
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DOI: https://doi.org/10.1007/s10620-012-2439-2