P0034 - Impact of Rapid On-Site Evaluation and Macroscopic On-Site Evaluation on the Diagnostic Accuracy of EUS-Guided Fine Needle Biopsy in Solid Pancreatic Lesions: A Systematic Review and Meta-Analysis
Ignacio A. Santos School of Medicine, Tecnológico de Monterrey Monterrey, Nuevo Leon, Mexico
Alan Gabriel Ortega-Macías, BS1, Mario A. O’Connor-Cordova, BS1, Juan Pablo Sancén-Herrera, BS1, Francisco Altamirano-Lamarque, BS1, Alexis Vargas-Del Toro, BS1, Bharat Kumar Peddinani, BS1, Thomas R. McCarty, MD, MPH2, Sergio A. Sánchez-Luna, MD3 1Ignacio A. Santos School of Medicine, Tecnológico de Monterrey, Monterrey, Nuevo Leon, Mexico; 2Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, TX; 3Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
Introduction: Endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) is a safe, feasible, and effective technique to accurately diagnose pancreatic solid lesions. With the development of the new generation of biopsy needles, the need for rapid on-site evaluation (ROSE) and macroscopic on-site evaluation (MOSE) to improve diagnostic accuracy and technique efficiency, remains a topic of debate.
Methods: Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine the impact of ROSE and MOSE on EUS-FNB diagnostic accuracy for adult patients with pancreatic solid lesions compared to EUS-FNB alone. Primary outcomes were diagnostic accuracy, sensitivity, and specificity and analyzed using random effects model for relative risk (RR) and standard mean difference (SMD). The risk of bias was assessed by the RoB 2 tool. The quality of evidence was graded using the GRADE guidelines.
Results:
Six studies describing the diagnostic accuracy of EUS-FNB+ROSE vs EUS-FNB alone for pancreatic solid lesions were included, totaling 1,970 patients. Meta-analysis test for overall effect showed no difference in terms of diagnostic accuracy for both groups [RR=0.99, (95% CI, 0.96-1.02); p=0.50] – Fig.1A. Similarly, 4 studies describing the diagnostic accuracy of EUS-FNB+MOSE vs EUS-FNB alone were analyzed, totaling 568 patients, with no difference in terms of diagnostic accuracy for both groups [RR=1.06 (95% CI, 0.88-1.28); p=0.37) – Fig.1B. In terms of sensitivity there was no statistically significant difference for ROSE [RR=1.05 (95% CI, 0.98-1.13); p=0.12] and MOSE [RR=1.11 (95% CI, 0.87-1.41; p=0.37] compared to EUS-FNB alone, respectively – Fig.2. Regarding specificity, no statistical significance was found comparing EUS-FNB+ROSE vs EUS-FNB alone [RR=1.03 (95% CI, 0.96-1.10); p=0.39] and EUS-FNB+MOSE vs EUS-FNB alone [RR=1.00 (95% CI, 0.97-1.02); p=0.9]. There was no difference in the mean number of passes in the EUS-FNB+MOSE [SMD=-0.56 (95% CI, -1.32-0.20); p=0.11), and EUS-FNB+ROSE [SMD =-0.19 (95% CI, -0.64-0.27); p=0.34) when compared to EUS-FNB alone. The risk of bias was low with moderate-to-high-quality of evidence.
Discussion: Our analysis suggests that the diagnostic accuracy, sensitivity, and specificity of EUS-FNB with the newer generation needles are not significantly improved either by ROSE or MOSE in patients with solid pancreatic lesions. Further randomized studies are needed to confirm these findings.
Figure: Figure 1. Meta-analysis of Diagnostic Accuracy of EUS-FNB+ROSE/MOSE vs EUS-FNB (EUS-FNB = endoscopic ultrasound-fine needle biopsy; ROSE = rapid onsite evaluation; MOSE = macroscopic onsite evaluation; RR = relative risk; CI = confidence interval). Figure 2. Meta-analysis of Sensitivity of EUS-FNB+ROSE/MOSE vs EUS-FNB (EUS-FNB = endoscopic ultrasound-fine needle biopsy; ROSE = rapid onsite evaluation; MOSE = macroscopic onsite evaluation; RR = relative risk; CI = confidence interval).
Disclosures:
Alan Gabriel Ortega-Macías indicated no relevant financial relationships.
Mario A. O’Connor-Cordova indicated no relevant financial relationships.
Juan Pablo Sancén-Herrera indicated no relevant financial relationships.
Francisco Altamirano-Lamarque indicated no relevant financial relationships.
Alexis Vargas-Del Toro indicated no relevant financial relationships.
Bharat Kumar Peddinani indicated no relevant financial relationships.
Thomas R. McCarty indicated no relevant financial relationships.
Sergio A. Sánchez-Luna: ASGE - Fujifilm Research Grant Award – Grant/Research Support.
Alan Gabriel Ortega-Macías, BS1, Mario A. O’Connor-Cordova, BS1, Juan Pablo Sancén-Herrera, BS1, Francisco Altamirano-Lamarque, BS1, Alexis Vargas-Del Toro, BS1, Bharat Kumar Peddinani, BS1, Thomas R. McCarty, MD, MPH2, Sergio A. Sánchez-Luna, MD3. P0034 - Impact of Rapid On-Site Evaluation and Macroscopic On-Site Evaluation on the Diagnostic Accuracy of EUS-Guided Fine Needle Biopsy in Solid Pancreatic Lesions: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
