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      Comparison of Franseen and fork-tip needles for EUS-guided fine-needle biopsy of solid mass lesions: A systematic review and meta-analysis

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          Abstract

          Franseen-tip and Fork-tip needles have been widely used in EUS guided fine-needle biopsy (FNB) of solid organs. There is conflicting data on the performance of these needles and unanswered questions on the ideal number of needle-passes and the requirement of an onsite cytopathologist (ROSE). We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (from inception through July 2018) to identify studies that reported on the use of Forktip and Franseen-tip needles in EUS-FNB of solid organs. The primary outcome was to estimate and compare the pooled rates of diagnostic-yield. A subgroup analysis compared the outcomes based on the number of needle-passes and the availability of ROSE. A total of 23 study-arms were available for analysis. The pooled rate of diagnostic yield with Fork-tip needle was 92.8% (95% CI 85.3 - 96.6, I 2 = 73.1) and the pooled rate of diagnostic yield with Franseen-tip needle was 92.7% (95% CI 86.4 - 96.2, I 2 = 88.4).

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          A meta-analysis of endoscopic ultrasound–fine-needle aspiration compared to endoscopic ultrasound–fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment

          Muhammad Khan, Ian S. Grimm, Bilal Ali … (2017)
          Background The diagnostic yield of endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is variable, and partly dependent upon rapid onsite evaluation (ROSE) by a cytopathologist. Second generation fine-needle biopsy (FNB) needles are being increasingly used to obtain core histological tissue samples. Aims Studies comparing the diagnostic yield of EUS guided FNA versus FNB have reached conflicting conclusions. We therefore conducted a systematic review and meta-analysis to compare the diagnostic yield of FNA with FNB, and specifically evaluating the diagnostic value of ROSE while comparing the two types of needles. Methods We searched several databases from inception to 10 April 2016 to identify studies comparing diagnostic yield of second generation FNB needles with standard FNA needles. Risk ratios (RR) were calculated for categorical outcomes of interest (diagnostic adequacy, diagnostic accuracy, and optimal quality histological cores obtained). Standard mean difference (SMD) was calculated for continuous variables (number of passes required for diagnosis). These were pooled using random effects model of meta-analysis to account for heterogeneity. Meta-regression was conducted to evaluate the effect of ROSE on various outcomes of interest. Results Fifteen studies with a total of 1024 patients were included in the analysis. We found no significant difference in diagnostic adequacy [RR 0.98 (0.91, 1.06), (I 2 = 51 %)]. Although not statistically significant (P = 0.06), by meta-regression, in the absence of ROSE, FNB showed a relatively better diagnostic adequacy. For solid pancreatic lesions only, there was no difference in diagnostic adequacy [RR 0.96 (0.86, 1.09), (I 2 = 66 %)]. By meta-regression, in the absence of ROSE, FNB was associated with better diagnostic adequacy (P = 0.02). There was no difference in diagnostic accuracy [RR 0.99 (0.95, 1.03), (I 2 = 27 %)] or optimal quality core histological sample procurement [RR 0.97 (0.89, 1.05), (I 2 = 9.6 %)]. However, FNB established diagnosis with fewer passes [SMD 0.93 (0.45, 1.42), (I 2 = 84 %)]. The absence of ROSE was associated with a higher SMD, i. e., in the presence of an onsite pathologist, FNA required relatively fewer passes to establish the diagnosis than in the absence of an onsite pathologist. Conclusions There is no significant difference in the diagnostic yield between FNA and FNB, when FNA is accompanied by ROSE. However, in the absence of ROSE, FNB is associated with a relatively better diagnostic adequacy in solid pancreatic lesions. Also, FNB requires fewer passes to establish the diagnosis.
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            Randomized trial comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy sampling of solid pancreatic mass lesions

            Muhammad Hasan, Ji Bang, Shantel Hebert-Magee … (2018)
            Recently, a 3-plane symmetric needle with Franseen geometry and a Fork-tip biopsy needle have been developed for histologic tissue procurement. We compared 22-gauge Franseen and 22-gauge Fork-tip needles in patients undergoing EUS-guided sampling of pancreatic masses.
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              EUS-guided fine needle biopsy sampling using a novel fork-tip needle: a case-control study.

              Pujan Kandel, Ghassan Tranesh, Aziza Nassar … (2016)
              EUS-guided fine needle biopsy (FNB) sampling and FNA are important methods for obtaining core tissues and cytologic aspirates. To improve the specimen quality for pathologic evaluation, a novel EUS-FNB Shark Core (SC) needle has been designed to acquire core tissue during EUS procedures. We compared the histology yield of EUS-FNB sampling using the SC needle (EUS-FNB-SC) to EUS-FNA in patients who had solid pancreatic and nonpancreatic lesions.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endosc Ultrasound
                Journal ID (iso-abbrev): Endosc Ultrasound
                Journal ID (publisher-id): EUS
                Title: Endoscopic Ultrasound
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 2303-9027
                ISSN (Electronic): 2226-7190
                Publication date Collection: Nov-Dec 2019
                Publication date (Electronic): 20 June 2019
                Volume: 8
                Issue: 6
                Pages: 382-391
                Affiliations
                [1]University of Arizona, Banner University Medical Center, Tucson, Arizona, USA
                [1 ]Rapides Regional Medical Center, Alexandria, Louisiana, USA
                [2 ]Cleveland Clinic Foundation, Cleveland, Ohio, USA
                [3 ]Division of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
                [4 ]Division of Gastroenterology/Hepatology, University of Nevada, Las Vegas, Nevada, USA
                [5 ]Department of Hospital Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
                [6 ]Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
                [7 ]Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
                Author notes
                Address for correspondence Dr. Douglas G. Adler, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, Utah 84132, USA. E-mail: douglas.adler@ 123456hsc.utah.edu
                Article
                Publisher ID: EUS-8-382
                DOI: 10.4103/eus.eus_27_19
                PMC ID: 6927147
                PubMed ID: 31249163
                SO-VID: 85c2f3cc-2ecf-4e94-9838-b1e610796a45
                Copyright © Copyright: © 2019 Spring Media Publishing Co. Ltd
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 24 August 2018
                Date accepted : 25 March 2019
                Categories
                Subject: Review Article

                Keywords: fine-needle biopsy,fork-tip needle,franseen-tip needle,rapid onsite evaluation
                Data availability:
                Keywords: fine-needle biopsy, fork-tip needle, franseen-tip needle, rapid onsite evaluation

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