Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis.
Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis.
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DOI：
10.1055/a-1293-7279
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发表时间：
2021-01
影响因子：
2.6
通讯作者：
Wani S
中科院分区：
文献类型：
--
作者：
Facciorusso A;Barresi L;Cannizzaro R;Antonini F;Triantafyllou K;Tziatzios G;Muscatiello N;Hart PA;Wani S
背景和研究目的：关于内镜超声（EUS）引导组织采集在自身免疫性胰腺炎（AIP）中的诊断性能的证据有限。 本荟萃分析的目的是提供EUS引导下细针抽吸（FNA）和细针活检（FNB）在AIP患者中诊断性能的汇总估计值。 患者和方法计算机化的文献检索进行到2020年1月。 使用随机效应模型通过DerSimonian和Laird检验计算合并效应。主要终点是与临床诊断标准相比的诊断准确性。其他结局包括明确的组织病理学、用于组织学诊断的充足材料的汇总率、样本充足性、平均穿刺次数。还分析了诊断敏感性和安全性数据。 结果共纳入15篇文献，共631例患者，其中4篇为前瞻性研究，1篇为随机对照研究。 EUS组织采集的总体诊断准确性为54.7%（95%置信区间，40.9%-68.4%），FNB明显优于FNA（63%，52.7%-73.4% vs 45.7%，26.5%-65%; p <0.001）。 细针穿刺活检对组织学一级诊断的阳性率为44.2%（30.8%~ 57.5%），而细针穿刺活检为21.9%（10%~ 33.7%）（P <0.001）. EUS组织取样的明确组织病理学诊断率为20.7%（12.9%-28.5%），FNB（24.3%，11.8%-36.8%）明显高于FNA（14.7%，5.4%-23.9%; P <0.001）。 不到1%的受试者发生术后急性胰腺炎。 结论本荟萃分析的结果表明，EUS引导组织采集在AIP患者中的诊断性能适中，与FNA相比，FNB的性能有所改善。
Background and study aims There is limited evidence on the diagnostic performance of endoscopic ultrasound (EUS)-guided tissue acquisition in autoimmune pancreatitis (AIP). The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) in patients with AIP. Patients and methods Computerized bibliographic search was performed through January 2020. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy compared to clinical diagnostic criteria. Additional outcomes were definitive histopathology, pooled rates of adequate material for histological diagnosis, sample adequacy, mean number of needle passes. Diagnostic sensitivity and safety data were also analyzed. Results Fifteen studies with 631 patients were included, of which four were prospective series and one randomized trial. Overall diagnostic accuracy of EUS tissue acquisition was 54.7 % (95 % confidence interval, 40.9 %–68.4 %), with a clear superiority of FNB over FNA (63 %, 52.7 % to 73.4 % versus 45.7 %, 26.5 %–65 %; p < 0.001). FNB provided level 1 of histological diagnosis in 44.2 % of cases (30.8 %–57.5 %) as compared to 21.9 % (10 %–33.7 %) with FNA ( P < 0.001). The rate of definitive histopathology of EUS tissue sampling was 20.7 % (12.9 %–28.5 %) and it was significantly higher with FNB (24.3 %, 11.8 %–36.8 %) as compared to FNA (14.7 %, 5.4 %–23.9 %; P < 0.001). Less than 1 % of subjects experienced post-procedural acute pancreatitis. Conclusion The results of this meta-analysis demonstrate that the diagnostic performance of EUS-guided tissue acquisition is modest in patients with AIP, with an improved performance of FNB compared to FNA.