P1075 - Endoscopic Ultrasound-Guided Fine Needle Aspiration for Suspected Pancreatic Malignancies in Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Mohamed Abdallah, MD¹, Khalid Ahmed, MD², Wesam Taha, MD³, Abubaker Abdalla, MBBS⁴, Abdullahi Musa, MBBS⁵, Hassan Taha, MBBS⁵, Mohammed Hamad, MBBS^6
1University of Minnesota Medical Center, Minneapolis, MN; ²Wright Center for Graduate Medical Education, Scranton, PA; ³New York Presbyterian Queens, Flushing, NY; ⁴Mayo Clinic, Rochester, MN; ⁵Howard University Hospital, Washington, DC; ⁶Flushing Hospital Medical Center, Flushing, NY

Introduction: Chronic pancreatitis (CP) promotes a higher risk of developing pancreatic adenocarcinoma compared to the general population with an estimated 5% risk of developing pancreatic cancer in 20 years. Endoscopic ultrasound fine needle aspiration (EUS-FNA) of solid pancreatic lesions (SPL) has a sensitivity of (85- 90%) and specificity of (98-100%) for diagnosing pancreatic malignancy. Data on the performance characteristics of EUS-FNA in CP is mixed.



In our systematic review and meta-analysis, we aim to examine data from published studies on the diagnostic ability of EUS-FNA in detecting pancreatic malignancy in CP.

Methods: We conducted a search of MEDLINE, Cochrane, EMBASE, Scopus databases for studies published in English language that reported performance characteristics of EUS-FNA for SPL up to November 2020. Two reviewers conducted screening, full text review, and data extraction according to the PRISMA guidelines. Quality of included studies was assessed using the risk of bias in non-randomized studies- of interventions (ROBINS-I) tool. Measured parameters were sensitivity, specificity, negative and positive likelihood ratios. Cochran Q test and I statistics were used to determine the between-study heterogeneity. Funnel plots were used to describe publication bias.

Results: Initially 6753 studies were identified. Studies that reported EUS-FNA of cystic pancreas lesions were excluded. 8 studies met the inclusion criteria. 7 studies were retrospective, and 1 was prospective. A total of 593 patients with CP underwent EUS-FNA for SPL. The sensitivity of EUS-FNA was 65% (95% CI: 52.6-75.6%, I² =44%), specificity was 96.8% (75-99.7%, I² = 89%), negative likelihood ratio (NLR) 41.4 (11.1-149.6, I²= 70%), positive likelihood ratio (PLR) 24.1 (2.8-208, I² =90%). The pooled data from 7 studies that compared 901 non-CP vs. 127 CP showed that the sensitivity of EUS-FNA in diagnosing pancreatic malignancy was 91.5 vs. 65.3% [OR (95% CI): 5.5 (2.9-10.2), I²: 31.8%]. The specificity pooled from 6 studies [333 non-CP vs. 357 CP] was 95.9% vs. 82.4%, [OR (95% CI): 1.3 (0.2-9.8), I² =73%] (Figure 2).The risk of bias was serious in 1 study, low in 4 studies and moderate in 3 studies.

Discussion: Our meta-analysis shows a low sensitivity of EUS-FNA in diagnosing malignancy in CP patients with SPL compared to patients without CP. EUS-fine needle biopsy has high sensitivity and specificity for diagnosing pancreatic cancer and should be considered in patients with CP and suspected pancreatic malignancy.


Figure: Figure 1
Figure 2


Disclosures:
Mohamed Abdallah indicated no relevant financial relationships.
Khalid Ahmed indicated no relevant financial relationships.
Wesam Taha indicated no relevant financial relationships.
Abubaker Abdalla indicated no relevant financial relationships.
Abdullahi Musa indicated no relevant financial relationships.
Hassan Taha indicated no relevant financial relationships.
Mohammed Hamad indicated no relevant financial relationships.


Mohamed Abdallah, MD¹, Khalid Ahmed, MD², Wesam Taha, MD³, Abubaker Abdalla, MBBS⁴, Abdullahi Musa, MBBS⁵, Hassan Taha, MBBS⁵, Mohammed Hamad, MBBS⁶. P1075 - Endoscopic Ultrasound-Guided Fine Needle Aspiration for Suspected Pancreatic Malignancies in Chronic Pancreatitis: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.