Fine Needle Aspiration vs Fine Needle Biopsy for Subepithelial Lesions: A Systematic Review and Meta-Analysis

Document Type

Abstract

Publication Date

6-1-2023

Abstract

Institutions: Saint Louis University, USA; Loyola University Health System, USA; Tower Health, USA. Disclosure compliance: I understand. Participant disclosure: Abdallah El Alayli: NO financial relationship with a commercial interest; Mashkurul Haque: NO financial relationship with a commercial interest; Elizabeth Anderson: NO financial relationship with a commercial interest; Ameya Deshmukh: NO financial relationship with a commercial interest; Parth Desai: NO financial relationship with a commercial interest; Eugene Nwankwo: NO financial relationship with a commercial interest; Maya Mahmoud: NO financial relationship with a commercial interest; Halim Bou Daher: NO financial relationship with a commercial interest; Umer Farooq: NO financial relationship with a commercial interest; Michelle Baliss: NO financial relationship with a commercial interest; Wissam Kiwan: NO financial relationship with a commercial interest. Introduction: Subepithelial lesions (SEL) are often incidentally discovered tumors arising from the muscularis mucosa, submucosa, or muscularis propria. Establishing a proper diagnosis for SELs is essential in determining the propensity for malignant transformation and ultimately determining management. Malignant potential cannot be reliably identified by endoscopic appearance, and adequate tissue acquisition is often required to reliably characterize these lesions through immunohistochemical staining. However, due to their location in the sub-epithelium, acquiring diagnostic samples from SELs can be challenging. Endoscopic ultrasound (EUS) can play a role in the characterization of SEL and potentially guide sample acquisition through fine needle aspiration (FNA) and biopsy (FNB). Previous systematic reviews comparing FNA and FNB showed higher accuracy and better diagnostic yield of FNB. Since the last systematic review, new studies have emerged on the topic. Aim: updated systematic review and meta-analysis to compare the outcomes of FNA vs FNB in patients with SEL. Methods: An information specialist conducted a search in PubMed, Medline, and Cochrane databases to identify relative studies through July 2022. We included randomized and non-randomized clinical trials conducted in humans and published in the English language. All steps were done in duplicate and reported based on the PRISMA guidelines. The population of interest is patients undergoing EUS FNA and EUS FNB for SELs. We included studies that compared directly FNA to FNB and excluded single-arm studies. The number of events were abstracted from included studies and were pooled using random effects models. The difference between the two techniques was assessed using the Odds ratio (OR) with the corresponding 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Results: The search identified 857 articles out of which we included 13 articles for the quantitative analysis with 2,586 patients (64% male). FNB was found to have higher adequate sample rates 93% as compared to FNA 90% however the comparison was not statistically significant aOR 1.74 [(95% CI 0.43; 6.82) I2 88%] (p=0.44). There was a statistically significant difference in diagnostic accuracy between FNA 94% and FNB 88% aOR 2.33 [(95% CI 1.77; 3.07) I2 81%] p< 0.001. The bleeding rate was higher than FNB (1.19%) and FNA (0.9%) however the difference was not statistically significant (p=0.62). There was no report of. Conclusion: Based on this systematic review and meta-analysis, FNB was found to have a higher rate of diagnostic accuracy when compared with FNA. There was not a significant difference in adequate sample rate or bleeding rate. Further studies are warranted to explore the cost-effectiveness of FNB versus FNA, which may help determine the optimal standard of care for SEL. [Formula presented]

Publication Title

Gastrointestinal Endoscopy

Volume

97

Issue

6 Supplement

First Page

AB838

Last Page

AB839

This document is currently not available here.

Open Access

Share

COinS