Abstract：
Evidence is limited on the comparative diagnostic performance of tissue sampling techniques for EUS-guided fine-needle biopsy sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare these techniques.
Rates of sample adequacy, blood contamination, and tissue integrity using fine-needle biopsy sampling needles were evaluated. Direct and indirect comparisons were performed among the slow-pull, dry-suction, modified wet-suction, or no-suction techniques. Results are expressed as risk ratio (RR) and 95% confidence interval (CI).
Overall, 9 randomized controlled trials (756 patients) were identified. On network meta-analysis, the no-suction technique was significantly inferior to the other techniques (RR, .85 [95% CI, .78-.92] vs slow pull; RR, .85 [95% CI, .78-.92] vs dry suction; RR, .83 [95% CI, .76-.90] vs modified wet suction) in terms of sample adequacy. Consequently, modified wet suction was shown to be the best technique (surface under the cumulative ranking curve score, .90), with the no-suction technique showing poorer performance in terms of sample adequacy (surface under the cumulative ranking curve score, .14). Dry suction was associated with significantly higher rates of blood contamination as compared with the slow-pull technique (RR, 1.44; 95% CI, 1.15-1.80), whereas no suction led to less blood contamination of samples in comparison with other techniques (RR, .71 [95% CI, .52-.97] vs slow pull; RR, .49 [95% CI, .36-.66] vs dry suction; RR, .57 [95% CI, .40-.81] vs modified wet suction). The modified wet-suction technique significantly outperformed dry suction in terms of tissue integrity of the sample (RR, 1.36; 95% CI, 1.06-1.75).
Modified wet suction seemed to provide high rates of integrity and adequate samples, albeit with high blood contamination. The no-suction technique performed significantly worse than other sampling strategies.
Rates of sample adequacy, blood contamination, and tissue integrity using fine-needle biopsy sampling needles were evaluated. Direct and indirect comparisons were performed among the slow-pull, dry-suction, modified wet-suction, or no-suction techniques. Results are expressed as risk ratio (RR) and 95% confidence interval (CI).
Overall, 9 randomized controlled trials (756 patients) were identified. On network meta-analysis, the no-suction technique was significantly inferior to the other techniques (RR, .85 [95% CI, .78-.92] vs slow pull; RR, .85 [95% CI, .78-.92] vs dry suction; RR, .83 [95% CI, .76-.90] vs modified wet suction) in terms of sample adequacy. Consequently, modified wet suction was shown to be the best technique (surface under the cumulative ranking curve score, .90), with the no-suction technique showing poorer performance in terms of sample adequacy (surface under the cumulative ranking curve score, .14). Dry suction was associated with significantly higher rates of blood contamination as compared with the slow-pull technique (RR, 1.44; 95% CI, 1.15-1.80), whereas no suction led to less blood contamination of samples in comparison with other techniques (RR, .71 [95% CI, .52-.97] vs slow pull; RR, .49 [95% CI, .36-.66] vs dry suction; RR, .57 [95% CI, .40-.81] vs modified wet suction). The modified wet-suction technique significantly outperformed dry suction in terms of tissue integrity of the sample (RR, 1.36; 95% CI, 1.06-1.75).
Modified wet suction seemed to provide high rates of integrity and adequate samples, albeit with high blood contamination. The no-suction technique performed significantly worse than other sampling strategies.
摘要：
目的：关于组织采样技术对内镜超声（EUS）引导的胰腺肿块细针活检（FNB）的比较诊断性能的证据有限。我们用网络荟萃分析进行了系统评价，以比较这些技术。
方法：样本充足率，血液污染,使用FNB针头评估组织完整性。在慢拉技术中进行了直接和间接比较，“干吸”，“改良湿吸”，或“无吸力”。结果表示为风险比（RR）和95％置信区间（CI）。
结果：总体而言，确定了9个RCTs（756例患者）。关于网络荟萃分析，在样本充分性方面，“无抽吸”技术明显劣于其他技术（RR0.85，95％CI0.78-0.92vs缓慢拉动；RR0.85，0.78-0.92vs“干吸”；RR0.83，0.76-0.90vs“改良湿吸”）。因此,“改良湿吸”是最佳技术(SUCRA0.90)，“无抽吸”在样本充分性方面表现较差(SUCRA评分0.14)。“干吸”与慢拉（RR1.44，1.15-1.80）相比，血液污染率明显更高。而与其他技术相比，“无抽吸”导致样品的血液污染较少（RR0.71，0.52-0.97与缓慢拉动；RR0.49，0.36-0.66与“干吸”；RR0.57，0.40-0.81与“改良湿吸”）。“改良湿吸”在样本组织完整性方面明显优于“干吸”(RR1.36,1.06-1.75)。
结论：“改良湿吸”似乎提供了较高的完整性和足够的样本，尽管血液污染严重。“无抽吸”技术的性能明显比其他采样策略差。
方法：样本充足率，血液污染,使用FNB针头评估组织完整性。在慢拉技术中进行了直接和间接比较，“干吸”，“改良湿吸”，或“无吸力”。结果表示为风险比（RR）和95％置信区间（CI）。
结果：总体而言，确定了9个RCTs（756例患者）。关于网络荟萃分析，在样本充分性方面，“无抽吸”技术明显劣于其他技术（RR0.85，95％CI0.78-0.92vs缓慢拉动；RR0.85，0.78-0.92vs“干吸”；RR0.83，0.76-0.90vs“改良湿吸”）。因此,“改良湿吸”是最佳技术(SUCRA0.90)，“无抽吸”在样本充分性方面表现较差(SUCRA评分0.14)。“干吸”与慢拉（RR1.44，1.15-1.80）相比，血液污染率明显更高。而与其他技术相比，“无抽吸”导致样品的血液污染较少（RR0.71，0.52-0.97与缓慢拉动；RR0.49，0.36-0.66与“干吸”；RR0.57，0.40-0.81与“改良湿吸”）。“改良湿吸”在样本组织完整性方面明显优于“干吸”(RR1.36,1.06-1.75)。
结论：“改良湿吸”似乎提供了较高的完整性和足够的样本，尽管血液污染严重。“无抽吸”技术的性能明显比其他采样策略差。
