Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review

<div><p>Background and Objectives</p><p>Rapid on-site evaluation (ROSE) during endoscopic ultrasonography-guided fine needle aspiration (EUS–FNA) of pancreatic masses has been reported to be associated with improved adequacy and diagnostic yield. However, recent observational data on the impact of ROSE have reported conflicting results. A meta-analysis and systematic review was therefore conducted to evaluate the contribution of ROSE during EUS-FNA of pancreatic masses.</p><p>Method</p><p>A systematic search was conducted in MEDLINE/Pubmed and EMBASE databases for studies comparing the efficacy of ROSE between patients in two cohorts. Outcomes considered included diagnostic adequate rate, diagnostic yield, number of needle passes, pooled sensitivity and specificity. Findings from a random-effects model were expressed as pooled risk difference (RD) with 95% confidence intervals (CIs).</p><p>Results</p><p>A total of 7 studies (1299 patients) was finally included and further analyzed in the current meta-analysis. EUS-FNA with ROSE could not improve diagnostic adequacy (RD = 0.05, 95% CI: -0.01–0.11) and diagnostic yield (RD = 0.04 95%CI: -0.05, 0.13). The number of needle passes showed no statistically significant difference with and without ROSE (RD = -0.68 95%CI: -2.35, 0.98). The pooled sensitivity and specificity of ROSE group were 0.91 (95%CI: 0.87, 0.94) and 1 (95%CI: 0.94, 1.00). The pooled sensitivity and specificity of non-ROSE group were 0.85 (95%CI: 0.80, 0.89) and 1 (95%CI: 0.95, 1.00). ROSE group and non-ROSE group showed comparable sensitivity and specificity.</p><p>Conclusion</p><p>Compared to historical reports of its clinical efficacy in patients with pancreatic lesions, ROSE may be not associated with an improvement of diagnostic yield, adequate rate, pooled sensitivity and specificity.</p></div

Forest plot displaying the Risk Difference and 95% CIs of each study for the adequacy rate.

<p>Forest plot displaying the Risk Difference and 95% CIs of each study for the adequacy rate.</p

Diagnostic performance for individual studies of meta-analysis comparing EUS-FNA with and without ROSE.

<p>Diagnostic performance for individual studies of meta-analysis comparing EUS-FNA with and without ROSE.</p

Flow chart of literature search and selection.

<p>Flow chart of literature search and selection.</p

Forest plot displaying the Risk Difference and 95% CIs of each study for the diagnosis yield.

<p>Forest plot displaying the Risk Difference and 95% CIs of each study for the diagnosis yield.</p

Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review - Fig 7

<p>Results for the non-ROSE group in individual studies and from pooled data shown as forest plots for: <b>a</b> sensitivity; <b>b</b> specificity. The <i>I</i>² result for heterogeneity is also stated (CI, confidence interval; df, degrees of freedom).</p

Forest plot displaying the Risk Difference and 95% CIs of each study for the diagnosis yield of malignancy.

<p>Forest plot displaying the Risk Difference and 95% CIs of each study for the diagnosis yield of malignancy.</p

Forest plot displaying the impact of assessor type to adequacy rate.

<p>Forest plot displaying the impact of assessor type to adequacy rate.</p

Weighted summary receiver operating characteristic (SROC) curve, with 95% confidence interval (CI), for studies involved.

<p><b>a</b> ROSE group; <b>b</b> non-ROSE group.</p

Table_1_Genomic and evolutionary characteristics of G9P[8], the dominant group a rotavirus in China (2016–2018).DOCX

G9P[8] became the predominant rotavirus A (RVA) genotype in China in 2012. To evaluate its genetic composition at the whole-genome level, 115 G9P[8] RVA strains isolated from children under 5 years old were sequenced and characterized. All 13 strains in 2016 and 2017 and an additional 54 strains in 2018 were genotyped as G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1. The other 48 strains in 2018 were all genotyped as G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E2-H1, with the NSP4 gene characterized as a DS-1-like genotype. The time of the most recent common ancestor (tMRCA) and evolution rates of the VP7, VP4, and NSP4 (E1 and E2) genes of these strains were estimated by Bayesian evolutionary dynamics analysis. We estimated the evolution rates (nt substitutions per site per year) as 1.38 × 10–3 [the 95% highest posterior density (HPD) was 1.09–1.72 × 10–3] for VP7, 0.87 × 10–3 (95% HPD: 0.75–1.00 × 10–3) for VP4, 0.56 × 10–3 (95% HPD: 0.41–0.73 × 10–3) for NSP4-E1, and 1.35 × 10–3 (95% HPD: 0.92–1.86 × 10–3) for NSP4-E2. The tMRCA was estimated to be 1935.4 (95% HPD: 1892.4–1961.3) for VP7, 1894.3 (95% HPD: 1850.5–1937.8) for VP4, 1929.4 (95% HPD: 1892.4–1961.3) for NSP4-E1, and 1969.2 (95% HPD: 1942.2–1985.3) for NSP4-E2. The baseline genetic information in this study is expected to improve our understanding of the genomic and evolutionary characteristics of the rotavirus genome. Furthermore, it will provide a basis for the development of next-generation rotavirus vaccines for humans.</p