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Endoscopic Ultrasonography-Guided Biopsy for Differentiation of Benign and Malignant Pelvic Lesions: A Systematic Review and Meta-Analysis

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Abstract

Background

Preoperative diagnosis of pelvic lesions remains challenging despite advances in imaging technologies. Endoscopic ultrasonography (EUS)-guided biopsy is an effective diagnostic modality for sampling the digestive tract and surrounding areas. However, a meta-analysis summarizing the diagnostic efficacy of EUS-guided biopsy for pelvic lesions has not been published.

Aims

We aimed to evaluate the utility of EUS-guided biopsy in the diagnosis of pelvic lesions.

Methods

Articles were identified via structured database search; only studies where pelvic lesions were confirmed by surgery or clinical follow-up were included. Data extracted were selected with strict criteria. A fixed-effects model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A summary receiver operating characteristic curve (SROC) was also constructed.

Results

Ten studies containing a total of 246 patients were included. The pooled sensitivity of EUS-guided biopsy for differential diagnosis of pelvic masses was 0.89 (95 % CI 0.83–0.94), and the specificity was 0.93 (95 % CI 0.86–0.97). The area under the SROC was 0.9631. The combined PLR, NLR, and DOR were 11.75 (95 % CI 5.90–23.43), 0.12 (95 % CI 0.07–0.20), and 100.06 (95 % CI 37.48–267.10) respectively. There is potential presence of publication bias in this meta-analysis.

Conclusions

Our meta-analysis shows that EUS-guided biopsy is a powerful tool for differentiating pelvic masses with a high sensitivity and specificity. Furthermore, it is a safe procedure with low rate of complication, although more high-quality prospective studies are required to be done.

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References

  1. Huh JW, Kwon SY, Lee JH, et al. Comparison of restaging accuracy of repeat FDG-PET/CT with pelvic MRI after preoperative chemoradiation in patients with rectal cancer. J Cancer Res Clin Oncol. 2015;141:353–359.

    Article  CAS  PubMed  Google Scholar 

  2. McDonald JM, Doran S, DeSimone CP, et al. Predicting risk of malignancy in adnexal masses. Obstet Gynecol. 2010;115:687–694.

    Article  PubMed  Google Scholar 

  3. Gupta S, Nguyen HL, Morello FA, et al. Various approaches for CT-guided percutaneous biopsy of deep pelvic lesions: anatomic and technical considerations. Radiographics. 2004;24:175–189.

    Article  PubMed  Google Scholar 

  4. Jurgensen C, Teubner A, Habeck JO, et al. Staging of rectal cancer by EUS: depth of infiltration in T3 cancers is important. Gastrointest Endosc. 2011;73:325–328.

    Article  PubMed  Google Scholar 

  5. Ramesh J, Bang JY, Trevino J, et al. Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses. J Gastroenterol Hepatol. 2013;28:620–625.

    Article  PubMed  Google Scholar 

  6. Puli SR, Bechtold ML, Buxbaum JL, et al. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass? A meta-analysis and systematic review. Pancreas. 2013;42:20–26.

    Article  PubMed  Google Scholar 

  7. Hewitt MJ, McPhail MJ, Possamai L, et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012;75:319–331.

    Article  PubMed  Google Scholar 

  8. Thornton GD, McPhail MJ, Nayagam S, et al. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology. 2013;13:48–57.

    Article  CAS  PubMed  Google Scholar 

  9. Vazquez-Sequeiros E, Levy MJ, Van Domselaar M, et al. Diagnostic yield and safety of endoscopic ultrasound guided fine needle aspiration of central mediastinal lung masses. Diagn Ther Endosc. 2013;2013:150492.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Oki M, Saka H, Ando M, et al. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer? J Thorac Cardiovasc Surg. 2014;148:1169–1177.

    Article  PubMed  Google Scholar 

  11. Mehmood S, Jahan A, Loya A, et al. Onsite cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions. Diagn Cytopathol. 2014;43:278–286.

    Article  PubMed  Google Scholar 

  12. Nieuwoudt M, Lameris R, Corcoran C, et al. Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy. Ultrasound Med Biol. 2014;40:2031–2038.

    Article  PubMed  Google Scholar 

  13. Lopes CV, Zereu M, Furian RD, et al. Retroperitoneal schwannoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Endoscopy. 2014;46:E287–288.

    Article  PubMed  Google Scholar 

  14. Sengupta S, Pal S, Biswas BK, et al. Fine-needle aspiration cytology of retroperitoneal lesions: a 5-year experience with an emphasis on cytohistological discrepancy. Acta Cytol. 2014;58:138–144.

    Article  PubMed  Google Scholar 

  15. Pinto-Pais T, Sousa-Fermandes S, Pontes JM, et al. Atypical pelvic recurrence of anal squamous cell carcinoma: successful endoscopic ultrasound-guided fine-needle aspiration through the sigmoid colon. Int J Colorectal Dis. 2014;30:139–140.

    Article  PubMed  Google Scholar 

  16. Rego R, Dang S, Lewis C. Use of a convex probe-endobronchial US endoscope in EUS of the rectum and FNA. Gastrointest Endosc. 2013;77:157–159.

    Article  PubMed  Google Scholar 

  17. Cantamessa A, Brunocilla PR, Carucci P, et al. Endoscopic ultrasound-guided fine needle aspiration in the diagnosis of pelvic metastasis of hepatocellular carcinoma: case report and review of literature. J Gastrointest Cancer. 2013;44:238–240.

    Article  PubMed  Google Scholar 

  18. Leeflang MM, Deeks JJ, Gatsonis C, et al. Systematic reviews of diagnostic test accuracy. Ann Intern Med. 2008;149:889–897.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. Jama. 2000;283:2008–2012.

    Article  CAS  PubMed  Google Scholar 

  20. Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Deville WL, Buntinx F, Bouter LM, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol. 2000;2:9.

    Article  Google Scholar 

  22. Zamora J, Abraira V, Muriel A, et al. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, et al. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11:193–206.

    Article  PubMed  Google Scholar 

  25. Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157–162.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58:882–893.

    Article  PubMed  Google Scholar 

  27. Rzouq F, Brown J, Fan F, et al. The utility of lower endoscopic ultrasound-guided fine needle aspiration for the diagnosis of benign and malignant pelvic diseases. J Clin Gastroenterol. 2014;48:127–130.

    Article  PubMed  Google Scholar 

  28. Amin K, Olyaee M, Tawfik O, et al. Endoscopic ultrasound-guided fine needle aspiration as a diagnostic and staging tool for rectal and perirectal lesions-an institutional experience. Ann Diagn Pathol. 2013;17:494–497.

    Article  PubMed  Google Scholar 

  29. Knight CS, Eloubeidi MA, Crowe R, et al. Utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of colorectal carcinoma. Diagn Cytopathol. 2013;41:1031–1037.

    Article  PubMed  Google Scholar 

  30. Maleki Z, Erozan Y, Geddes S, et al. Endorectal ultrasound-guided fine-needle aspiration: a useful diagnostic tool for perirectal and intraluminal lesions. Acta Cytol. 2013;57:9–18.

    Article  PubMed  Google Scholar 

  31. Gleeson FC, Clain JE, Karnes RJ, et al. Endoscopic-ultrasound-guided tissue sampling facilitates the detection of local recurrence and extra pelvic metastasis in pelvic urologic malignancy. Diagn Ther Endosc. 2012;219:521.

    Google Scholar 

  32. Mohamadnejad M, Al-Haddad MA, Sherman S, et al. Utility of EUS-guided biopsy of extramural pelvic masses. Gastrointest Endosc. 2012;75:146–151.

    Article  PubMed  Google Scholar 

  33. Boo SJ, Byeon JS, Park do H, et al. EUS-guided fine needle aspiration and trucut needle biopsy for examination of rectal and perirectal lesions. Scand J Gastroenterol. 2011;46:1510–1518.

    Article  PubMed  Google Scholar 

  34. Sasaki Y, Niwa Y, Hirooka Y, et al. The use of endoscopic ultrasound-guided fine-needle aspiration for investigation of submucosal and extrinsic masses of the colon and rectum. Endoscopy. 2005;37:154–160.

    Article  CAS  PubMed  Google Scholar 

  35. Vander Noot MR 3rd, Eloubeidi MA, Chen VK, Eltoum I, et al. Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2004;102:157–163.

    Article  PubMed  Google Scholar 

  36. Sailer M, Bussen D, Fein M, et al. Endoscopic ultrasound-guided transrectal biopsies of pelvic tumors. J Gastrointest Surg. 2002;6:342–346.

    Article  PubMed  Google Scholar 

  37. Anand D, Barroeta JE, Gupta PK, et al. Endoscopic ultrasound guided fine needle aspiration of non-pancreatic lesions: an institutional experience. J Clin Pathol. 2007;60:1254–1262.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Attila T, Faigel DO. Endoscopic ultrasound in patients over 80 years old. Dig Dis Sci. 2011;56:3065–3071.

    Article  PubMed  Google Scholar 

  39. Chhieng DC, Jhala D, Jhala N, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy: a study of 103 cases. Cancer. 2002;96:232–239.

    Article  PubMed  Google Scholar 

  40. Gerke H, Rizk MK, Vanderheyden AD, et al. Randomized study comparing endoscopic ultrasound-guided Trucut biopsy and fine needle aspiration with high suction. Cytopathology. 2010;21:44–51.

    Article  CAS  PubMed  Google Scholar 

  41. Hussain T, Salamat A, Farooq MA, et al. Indications for endoscopic ultrasound and diagnosis on fine-needle aspiration and cytology. J Coll Phys Surg Pak. 2009;19:223–227.

    Google Scholar 

  42. Morken JJ, Baxter NN, Madoff RD, et al. Endorectal ultrasound-directed biopsy: a useful technique to detect local recurrence of rectal cancer. Int J Colorectal Dis. 2006;21:258–264.

    Article  PubMed  Google Scholar 

  43. Hunerbein M, Totkas S, Moesta KT, et al. The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer. Surgery. 2001;129:164–169.

    Article  CAS  PubMed  Google Scholar 

  44. Levy MJ, Gleeson FC, Campion MB, et al. Prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS: a potential source of false-positive FNA and needle tract seeding. Am J Gastroenterol. 2010;105:1311–1318.

    Article  PubMed  Google Scholar 

  45. Gleeson FC, Kipp BR, Caudill JL, et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut. 2010;59:586–593.

    Article  PubMed  Google Scholar 

  46. Banerjee S, Shen B, Baron TH, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2008;67:791–798.

    Article  PubMed  Google Scholar 

  47. Levy MJ, Norton ID, Clain JE, et al. Prospective study of bacteremia and complications With EUS FNA of rectal and perirectal lesions. Clin Gastroenterol Hepatol. 2007;5:684–689.

    Article  PubMed  Google Scholar 

  48. Cho CM, Al-Haddad M, Leblanc JK, et al. Rescue endoscopic ultrasound (EUS)-guided Trucut biopsy following suboptimal eus-guided fine needle aspiration for mediastinal lesions. Gut Liver. 2013;7:150–156.

    Article  PubMed Central  PubMed  Google Scholar 

  49. El H II, LeBlanc JK, Sherman S, et al. Endoscopic ultrasound-guided biopsy of pancreatic metastases: a large single-center experience. Pancreas. 2013;42:524–530.

    Article  Google Scholar 

  50. Puli SR, Batapati Krishna Reddy J, Bechtold ML, et al. Endoscopic ultrasound: it’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review. World J Gastroenterol. 2008;14:3028–3037.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Chen G, Liu S, Zhao Y, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a meta-analysis. Pancreatology. 2013;13:298–304.

    Article  PubMed  Google Scholar 

  52. Catalano MF, Sial S, Chak A, et al. EUS-guided fine needle aspiration of idiopathic abdominal masses. Gastrointest Endosc. 2002;55:854–858.

    Article  PubMed  Google Scholar 

  53. Matsui N, Akahoshi K, Motomura Y, et al. Successful endoscopic ultrasound-guided fine-needle aspiration of the pelvic lesion through the sigmoid colon. Dig Endosc. 2010;22:337–340.

    Article  PubMed  Google Scholar 

  54. Honda K, Akahoshi K, Matsui N, et al. Role of EUS and EUS-guided FNA in the diagnosis of rectal implantation cyst at an anastomosis site after a previous low anterior resection for a rectal cancer without evidence of cancer recurrence. Gastrointest Endosc. 2008;68:782–785.

    Article  PubMed  Google Scholar 

  55. Gleeson FC, Larson DW, Dozois EJ, et al. Local recurrence detection following transanal excision facilitated by EUS-FNA. Hepatogastroenterology. 2012;59:1102–1107.

    PubMed  Google Scholar 

  56. Gleeson FC, Clain JE, Rajan E, et al. EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc. 2011;74:897–905.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported in part by the National Natural Science Foundation of China (Nos. 81000160, 81272656, 30900664, 81470039, and 81170373).

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    Authors and Affiliations

    1. Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

      Chaoqun Han, Rong Lin, Jun Liu, Xiaohua Hou, Wei Qian & Zhen Ding

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    1. Chaoqun Han
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    Correspondence to Zhen Ding.

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    Chaoqun Han and Rong Lin contributed equally to this work.

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    Han, C., Lin, R., Liu, J. et al. Endoscopic Ultrasonography-Guided Biopsy for Differentiation of Benign and Malignant Pelvic Lesions: A Systematic Review and Meta-Analysis. Dig Dis Sci 60, 3771–3781 (2015). https://doi.org/10.1007/s10620-015-3831-5

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