Journal of Cancer Research and Clinical Oncology

, Volume 138, Issue 9, pp 1433–1441 | Cite as

Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesion: a systematic review

  • Jiong Chen
  • Renbao Yang
  • Yin Lu
  • Yunlian Xia
  • Hangcheng Zhou



To summarize EUS-FNA test performance in suspected pancreatic malignancy with meta-analysis.


Two reviewers searched MEDLINE (PubMed and Ovid from January 2002 to January 2012) database to identify relevant studies. The reference lists of the trials were manually searched. Included studies used histopathology or clinical and morphological (CT and MRI and US) follow-up as the “gold standard” and provided sufficient data to construct a diagnostic 2 × 2 table. A statistical program of Meta-Disc was used to calculate the pooled sensitivity, specificity, positive LR, negative LR, DOR, and the SROC curve. Subgroup analysis and meta-regression were calculated to evaluate potential sources of heterogeneity.


A total of 15 studies with 1860 patients were included for the analysis. The pooled sensitivity and specificity of EUS-FNA were 92 % (95 % CI = 91–93 %, p < 0.001, I 2 = 69.6 %) and 96 % (95 % CI = 93–98 %, p = 0.006, I 2 = 54.9 %), respectively. The positive LR and negative LR were 14.24 (95 % CI = 7.78–26.07) and 0.09 (95 % CI = 0.07–0.13), respectively. The area under the curve was 0.974. The subgroup analysis of six studies with rapid on-site evaluation (ROSE) showed a pooled sensitivity of 95 % (95 % CI = 93–96 %), with p value equal 0.622 and I 2 = 0. The sensitivity analysis of ten high-quality studies (a score of ≥4) showed a pooled sensitivity of 94 % (95 % CI = 93–96 %, p = 0.144, I 2 = 33.1 %), and the pooled specificity was 0.95 (95 % CI, 0.91–0.97).


EUS-FNA had overall excellent specificity and sensitivity in accurately diagnosing solid pancreatic masses. ROSE could help to improve the accuracy of diagnostic test.


Solid pancreatic lesion Endoscopic ultrasound Fine-needle aspiration Diagnosis Meta-analysis 


Conflict of interest



  1. Artifon EL, Couto D Jr, Sakai P, da Silveira EB (2009) Prospective evaluation of EUS versus CT scan for staging of ampullary cancer. Gastrointest Endosc 70:290–296PubMedCrossRefGoogle Scholar
  2. Beane JD, House MG, Coté GA et al (2011) Outcomes after preoperative endoscopic ultrasonography and biopsy in patients undergoing distal pancreatectomy. Surgery 150:844–853PubMedCrossRefGoogle Scholar
  3. Bossuyt PM, Reitsma JB, Bruns DE et al (2003) The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. The standards for reporting of Diagnostic Accuracy Group. Croat Med J 44:639–650PubMedGoogle Scholar
  4. Cherian PT, Mohan P, Douiri A, Taniere P, Hejmadi RK, Mahon BS (2010) Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic and peripancreatic lesions: is onsite cytopathology necessary? HPB (Oxford) 12(6):389–395CrossRefGoogle Scholar
  5. Devillé WL, Buntinx F, Bouter LM (2002) Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2:9PubMedCrossRefGoogle Scholar
  6. Eloubeidi MA, Chen VK, Eltoum IA et al (2003) Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol 98:2663–2668PubMedGoogle Scholar
  7. Fisher L, Segarajasingam DS, Stewart C, Deboer WB, Yusoff IF (2009) Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: performance and outcomes. J Gastroenterol Hepatol 24:90–96PubMedCrossRefGoogle Scholar
  8. Ghaneh P, Costello E, Neoptolemos JP (2007) Biology and management of pancreatic cancer. Gut 56:1134–1152PubMedCrossRefGoogle Scholar
  9. Harewood GC, Wiersema MJ (2002) Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol 97:1386–1391PubMedCrossRefGoogle Scholar
  10. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560PubMedCrossRefGoogle Scholar
  11. Hikichi T, Irisawa A, Bhutani MS et al (2009) Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol 44:322–328PubMedCrossRefGoogle Scholar
  12. Iglesias-Garcia J, Dominguez-Munoz E, Lozano-Leon A, Abdulkader I, Larino-Noia J, Antunez J, Forteza J (2007) Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses. World J Gastroenterol 13:289–293PubMedGoogle Scholar
  13. Iglesias-Garcia J, Dominguez-Munoz JE et al (2011) Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 106:1705–1710PubMedCrossRefGoogle Scholar
  14. Irwig L, Macaskill P, Glasziou P, Fahey M (1995) Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol 48:119–130PubMedCrossRefGoogle Scholar
  15. James TA, Gibbs JF (2005) Pancreatic cancer screening:identifying premalignant disease. Future Oncol 1:191–195PubMedCrossRefGoogle Scholar
  16. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66PubMedCrossRefGoogle Scholar
  17. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249PubMedCrossRefGoogle Scholar
  18. Karoumpalis I, Sigalas P, Salla C, Diakatou E, Balatsos V, Zografos G, Delis V (2011) Endoscopic ultrasound staging and guided fine needle aspiration biopsy in patients with resectable pancreatic malignancies: a single-center prospective experience. Onkologie 34(10):533–537PubMedCrossRefGoogle Scholar
  19. Kliment M, Urban O, Cegan M et al (2010) Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients. Scand J Gastroenterol 45:1372–1739PubMedCrossRefGoogle Scholar
  20. Krishna NB, LaBundy JL, Saripalli S, Safdar R, Agarwal B (2009) Diagnostic Value of EUS-FNA in Patients Suspected of Having Pancreatic Cancer With a Focal Lesion on CT Scan/MRI but Without Obstructive Jaundice. Pancreas 38:625–630PubMedCrossRefGoogle Scholar
  21. Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149:889–897PubMedGoogle Scholar
  22. Matsuda T, Marugame T, Kamo KL et al (2008) Cancer incidence and incidence rates in Japan in 2002: base on data from 11 population base cancer registries. Jpn J Clin Oncol 38:641–648PubMedCrossRefGoogle Scholar
  23. Meijer OL, Weersma RK, van der Jagt EJ, van Dullemen HM (2010) Endoscopic ultrasonography in suspected pancreatic malignancy and indecisive CT. Neth J Med 68:360–364PubMedGoogle Scholar
  24. Mertz HR, Sechopoulos P, Delbeke D, Leach SD (2000) EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc 52:367–371PubMedCrossRefGoogle Scholar
  25. Nguyen YP, Maple JT, Zhang Q et al (2009) Reliability of gross visual assessment of specimen adequacy during EUS-guided FNA of pancreatic masses. Gastrointest Endosc 69:1264–1270PubMedCrossRefGoogle Scholar
  26. Raddaoui E (2011) Clinical utility and diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions: Saudi Arabian experience. Acta Cytol 55:26–29PubMedCrossRefGoogle Scholar
  27. Raut CP, Grau AM, Staerkel GA et al (2003) Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg 7:118–126 (discussion 127-8)PubMedCrossRefGoogle Scholar
  28. Rocca R, De Angelis C, Daperno M et al (2007) Endoscopic ultrasound-fine needle aspiration EUS-FNA) for pancreatic lesions: effectiveness in clinical practice. Dig Liver Dis 39:768–774PubMedCrossRefGoogle Scholar
  29. Ryozawa S, Kitoh H, Gondo T et al (2005) Usefulness of endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of pancreatic cancer. J Gastroenterol 40:907–911PubMedCrossRefGoogle Scholar
  30. Săftoiu A, Popescu C, Cazacu S et al (2006) Power Doppler endoscopic ultrasonography for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis. J Ultrasound Med 25:363–372PubMedGoogle Scholar
  31. Siddiqui AA, Kowalski TE, Shahid H et al (2011) False-positive EUS-guided FNA cytology for solid pancreatic lesions. Gastrointest Endosc 74:535–540PubMedCrossRefGoogle Scholar
  32. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012PubMedCrossRefGoogle Scholar
  33. Takahashi K, Yamao K, Okubo K et al (2005) Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA. Gastrointest Endosc 61:76–79PubMedCrossRefGoogle Scholar
  34. Thosani N, Thosani S, Qiao W, Fleming JB, Bhutani MS, Guha S (2010) Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig Dis Sci 55:2756–2766PubMedCrossRefGoogle Scholar
  35. Touchefeu Y, Le Rhun M, Coron E, Alamdari A, Heymann MF, Mosnier JF, Matysiak T, Galmiche JP (2009) Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of solid pancreatic masses: the impact on patient-management strategy. Aliment Pharmacol Ther 30:1070–1077PubMedCrossRefGoogle Scholar
  36. Uehara H, Ikezawa K, Kawada N et al (2011) Diagnostic accuracy of endoscopic ultrasound-guided f ine needle aspiration for suspected pancreatic malignancy in relation to the size of lesions. J Gastroenterol Hepatol 26:1256–1261PubMedCrossRefGoogle Scholar
  37. Vilmann P, Jacobsen GK, Henriksen FW et al (1992) Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 38:172–173PubMedCrossRefGoogle Scholar
  38. Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB (2005) Pancreatic FNA in 1000 cases: a comparison of imaging modalities. Gastrointest Endosc 61:854–861PubMedCrossRefGoogle Scholar
  39. Wilson JL, Kalade A, Prasad S, Cade R, Thomson B, Banting S, Mackay S, Desmond PV, Chen RY (2009) Diagnosis of solid pancreatic masses by endoscopic ultrasound-guided fine-needle aspiration. Intern Med J 39:32–37PubMedCrossRefGoogle Scholar
  40. Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Jiong Chen
    • 1
  • Renbao Yang
    • 1
  • Yin Lu
    • 1
  • Yunlian Xia
    • 1
  • Hangcheng Zhou
    • 1
  1. 1.Department of General SurgeryAffiliated Provincial Hospital of Anhui Medical UniversityHefeiChina

Personalised recommendations