Abstract
BackgroundPrevious studies have demonstrated that endoscopic ultrasound-fine needle aspiration (EUS-FNA) is a reliable tool for diagnosing pancreatic lesions; however, the reported sensitivity and specificity vary greatly across studies. The aim of this study was to pool the existing literature and assess the overall performance of EUS-FNA in the diagnosis of solid pancreatic lesions.MethodsA systematic search of MEDLINE, Cochrane Database for Systematic Reviews, and EMBASE was performed to identify original and review articles published between January 1995 and January 2014 that reported the accuracy of EUS-FNA in the diagnosis of pancreatic masses. Quality of the included studies was assessed using the quality assessment of diagnosis accuracy studies score tool. Meta-DiSc software was used to calculate the pooled sensitivity and specificity, positive and negative likelihood ratios, and to construct the summary receiver operating characteristics curve.ResultsTwenty studies involving a total of 2,761 patients were included in the study. The pooled sensitivity and specificity of EUS-FNA in the diagnosis of solid pancreatic lesions were 90.8 % [95 % confidence interval (CI), 89.4–92 %] and 96.5 % (95 % CI, 94.8–97.7 %), respectively. The positive and negative likelihood ratios were 14.8 (95 % CI, 8.0–27.3) and 0.12 (95 % CI, 0.09–0.16), respectively. The overall diagnostic accuracy was 91.0 %.ConclusionsOur findings suggest that EUS-FNA has high sensitivity and specificity in the diagnosis of solid pancreatic lesions.
Highlights
Previous studies have demonstrated that endoscopic ultrasound-fine needle aspiration (EUS-FNA) is a reliable tool for diagnosing pancreatic lesions; the reported sensitivity and specificity vary greatly across studies
Pancreatic lesions encompass a variety of benign and malignant conditions, and the diagnosis of pancreatic cancer is complicated by indistinct detection of pancreatic masses either clinically or by imaging
The diagnosis of a regional pancreatic mass may be confused with that of a primary pancreatic tumor, as in pancreatic adenocarcinoma, while focal chronic pancreatitis may be confused with pancreatic metastasis from a distant primary tumor [3]
Summary
Previous studies have demonstrated that endoscopic ultrasound-fine needle aspiration (EUS-FNA) is a reliable tool for diagnosing pancreatic lesions; the reported sensitivity and specificity vary greatly across studies. The aim of this study was to pool the existing literature and assess the overall performance of EUS-FNA in the diagnosis of solid pancreatic lesions. Pancreatic cancer is difficult to diagnose in its early stages, and nearly 26 % of all diagnosed cases have regional spread, with 52 % of cases reported to have metastatic disease at the time of diagnosis [2]. Since curative resection is currently the only potential cure for patients with pancreatic cancer, early diagnosis has an important impact on prognosis. Pancreatic lesions encompass a variety of benign and malignant conditions, and the diagnosis of pancreatic cancer is complicated by indistinct detection of pancreatic masses either clinically or by imaging. Accurate preoperative diagnosis is essential for selecting an appropriate treatment for these lesions [4]
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