Post written by Antonio Facciorusso, PhD, from the Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy, and the Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.

The development of EUS-guided fine-needle biopsy (FNB) needles has generated a great deal of interest in the field of EUS tissue acquisition of solid pancreatic lesions. 

However, despite the potential advantages, the first-generation standard FNB reverse-bevel needle failed to provide significantly superior results than fine-needle aspiration (FNA) needles.  

In recent years, newer FNB needles that feature alterations of the cutting tip have been developed. Given the limited data on the comparative diagnostic accuracy and sample adequacy of different end-cutting needles, we decided to perform pairwise and network meta-analyses comparing their performance to each other and standard reverse-bevel FNB and FNA needles.

Recently, several randomized controlled trials (RCTs) comparing sizes and designs of these newer end-cutting needles have been published. Therefore, a systematic review with network meta-analysis of the growing body of evidence provided by these RCTs was expected to inform clinical practice in this field.

Based on our network meta-analysis of 16 RCTs, we made several key observations. First, both Franseen and Fork-tip FNB needles significantly outperformed reverse-bevel needles. On the other hand, another newer end-cutting device, the Menghini-tip needle, outperformed the reverse-bevel needle only in terms of sample adequacy without a significant impact on diagnostic accuracy. Therefore, Franseen and Fork-tip needles ranked as the best performers for tissue sampling of pancreatic masses.

The second key observation was that 22-guage Franseen and Fork-tip devices ranked as the best-performing needles in sensitivity analysis based on size. Of note, the 25-guage Franseen and Fork-tip needles did not outperform the 22-guage reverse-bevel FNB needle.

The third observation was that when rapid onsite cytologic evaluation was available, none of the mentioned FNB needles were significantly superior to FNA.

In addition, the 20-guage side-fenestrated forward-facing bevel needle was not superior to the other devices including the standard FNA needle. However, this finding should be interpreted with caution because of the low number of RCTs using this needle.

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