Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis

doi:10.5662/wjm.v15.i3.97415

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World Journal of Methodology

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Meta-Analysis

World J Methodol. Sep 20, 2025; 15(3): 97415
Published online Sep 20, 2025. doi: 10.5662/wjm.v15.i3.97415

Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis

Suprabhat Giri, Manas Kumar Panigrahi, Ranjan K Patel, Tara Prasad Tripathy, Jijo Varghese, Prajna Anirvan, Mitali Madhumita Rath

Mitali Madhumita Rath, Department of Pathology, IMS and SUM Hospital Campus-2, Bhubaneshwar 754001, Odisha, India

Prajna Anirvan, Department of Gastroenterology, Kalinga Gastroenterology Foundation, Cuttack 753001, Odisha, India

Jijo Varghese, Department of Gastroenterology, NS Memorial Institute of Medical Sciences, Kollam 691020, Kerala, India

Tara Prasad Tripathy, Ranjan K Patel, Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India

Manas Kumar Panigrahi, Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India

Suprabhat Giri, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India

Co-first authors: Mitali Madhumita Rath and Prajna Anirvan.

Author contributions: Panigrahi MK and Giri S contributed to the conception and design of the manuscript; Rath MM, Anirvan P, Varghese J, Tripathy TP, Patel RK, and Giri S contributed to the literature review, analysis, data collection, and interpretation; Rath MM, Anirvan P, and Giri S drafted the initial manuscript; Rath MM, Panigrahi MK and Giri S contributed to the critical revision of the initial manuscript; All the authors approved the final version of the manuscript.

Conflict-of-interest statement: All the authors declare no conflict of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2021 Checklist, and the manuscript was prepared and revised according to the PRISMA 2021 Checklist.

Corresponding author: Suprabhat Giri, DM, Assistant Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Kushabhadra Campus, 5 KIIT Rd, Patia, Bhubaneswar 751024, Odisha, India. supg19167@gmail.com

Received: May 29, 2024
Revised: November 3, 2024
Accepted: December 2, 2024
Published online: September 20, 2025
Processing time: 280 Days and 18.5 Hours

Abstract

BACKGROUND

Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the most common modality for tissue acquisition from pancreatic masses. Despite high specificity, sensitivity remains less than 90%. Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically. However, data regarding the same have shown conflicting results.

AIM

To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.

METHODS

The electronic databases of MEDLINE, EMBASE, and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions. A bivariate hierarchical model was used to perform the meta-analysis.

RESULTS

A total of 10 studies were identified. The pooled sensitivity, specificity, and area under the receiver-operated curve (AUROC) for standard EUS-FNA/B were 0.82 (95%CI: 0.79-0.85), 1.00 (95%CI: 0.96-1.00), and 0.97 (95%CI: 0.95-0.98), respectively. The pooled sensitivity, specificity, and AUROC for EUS-FNA/B with auxiliary techniques were 0.86 (95%CI: 0.83-0.89), 1.00 (95%CI: 0.94-1.00), and 0.96 (95%CI: 0.94-0.98), respectively. Comparing the two diagnostic modalities, sensitivity [Risk ratio (RR): 1.04, 95%CI: 0.99-1.09], specificity (RR: 1.00, 95%CI: 0.99-1.01), and diagnostic accuracy (RR: 1.03, 95%CI: 0.98-1.09) were comparable.

CONCLUSION

Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B. Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.

Keywords: Endoscopic ultrasonography; Fine-needle aspiration Biopsies; Pancreatic ductal carcinomas; Contrast media; Elastography

Core Tip: Auxiliary techniques like elastography and contrast enhancement are being used during endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) to guide tissue acquisition from viable tumor tissue and improve diagnostic outcomes. However, the present meta-analysis reported comparable sensitivity, specificity, and diagnostic accuracy between EUS-FNA/B with and without auxiliary techniques. Subgroup analysis of studies exclusively using contrast-enhanced harmonic-EUS-FNA/B, randomized studies, and studies reporting diagnostic outcomes after the first pass reported no difference between both modalities. Thus, using EUS-FNA/B with auxiliary techniques for pancreatic solid lesions does not provide any additional advantage over standard EUS-FNA/B.