How Good Is Endoscopic Ultrasound–Guided Fine-Needle Aspiration in Diagnosing the Correct Etiology for a Solid Pancreatic Mass?: A Meta-Analysis and Systematic Review

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Abstract

Objectives

The objective of this study was to evaluate the accuracy of endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) in diagnosing the correct etiology for a solid pancreatic mass.

Method

Data extracted from EUS-FNA studies with a criterion standard (either confirmed by surgery or appropriate follow-up) were selected. Articles were searched in MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Pooling was conducted by both fixed- and random-effects models.

Results

Initial search identified 3610 reference articles, of these 360 relevant articles were selected and reviewed. Data were extracted from 41 studies (N = 4766) which met the inclusion criteria. Pooled sensitivity of EUS-FNA in diagnosing the correct etiology for solid pancreatic mass was 86.8% (95% confidence interval [CI], 85.5–87.9). Endoscopic ultrasound–guided FNA had a pooled specificity of 95.8% (95% CI, 94.6–96.7). Positive likelihood ratio of EUS was 15.2 (95% CI, 8.5–27.3), and the negative likelihood ratio was 0.17 (95% CI, 0.13–0.21).

Conclusions

Endoscopic ultrasound–guided FNA is an excellent diagnostic tool to detect the correct etiology for solid pancreatic masses. When available, EUS-FNA should be strongly considered as the first diagnostic tool for sampling these lesions to optimize patient management.

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