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Genetic testing vs microforceps biopsy in pancreatic cysts: Systematic review and meta-analysis

dc.contributor.authorFaias, Sandra
dc.contributor.authorPereira, L.
dc.contributor.authorLuís, Ângelo
dc.contributor.authorChaves, Paula
dc.contributor.authorCravo, Marília
dc.date.accessioned2020-01-28T16:44:58Z
dc.date.available2020-01-28T16:44:58Z
dc.date.issued2019-07-14
dc.description.abstractBackground: Carcinoembryonic antigen (CEA) and cytology in pancreatic cystic fluid are suboptimal for evaluation of pancreatic cystic neoplasms. Genetic testing and microforceps biopsy are promising tools for pre-operative diagnostic improvement but comparative performance of both methods is unknown. Aim: To compare the accuracy of genetic testing and microforceps biopsy in pancreatic cysts referred for surgery. Methods: We performed a literature search in Medline, Scopus, and Web of Science for studies evaluating genetic testing of cystic fluid and microforceps biopsy of pancreatic cysts, with endoscopic ultrasound with fine-needle aspiration (EUS-FNA) prior to surgery and surgical pathology as reference standard for diagnosis. We evaluated the diagnostic accuracy for: 1- benign cysts; 2- mucinous low-risk cysts; 3- high-risk cysts, and the diagnostic yield and rate of correctly identified cysts with microforceps biopsy and molecular analysis. We also assessed publication bias, heterogeneity, and study quality. Results: Eight studies, including 1206 patients, of which 203 (17%) referred for surgery who met the inclusion criteria were analyzed in the systematic review, and seven studies were included in the meta-analysis. Genetic testing and microforceps biopsies were identical for diagnosis of benign cysts. Molecular analysis was superior for diagnosis of both low and high-risk mucinous cysts, with sensitivities of 0.89 (95%CI: 0.79-0.95) and 0.57 (95%CI: 0.42-0.71), specificities of 0.88 (95%CI: 0.75-0.95) and 0.88 (95%CI: 0.80-0.93) and AUC of 0.9555 and 0.92, respectively. The diagnostic yield was higher in microforceps biopsies than in genetic analysis (0.73 vs 0.54, respectively) but the rates of correctly identified cysts were identical (0.73 with 95%CI: 0.62-0.82 vs 0.71 with 95%CI: 0.49-0.86, respectively). Conclusion: Genetic testing and microforceps biopsies are useful second tests, with identical results in benign pancreatic cysts. Genetic analysis performs better for low- and high-risk cysts but has lower diagnostic yield.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.3748/wjg.v25.i26.3450pt_PT
dc.identifier.eissn2219-2840
dc.identifier.issn1007-9327
dc.identifier.urihttp://hdl.handle.net/10400.6/8825
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/pt_PT
dc.subjectCarcinoembryonic antigenpt_PT
dc.subjectCytologypt_PT
dc.subjectEndoscopic ultrasoundpt_PT
dc.subjectEndoscopic ultrasound with fine-needle aspirationpt_PT
dc.subjectGenetic testingpt_PT
dc.subjectKRASpt_PT
dc.subjectMicroforceps biopsypt_PT
dc.subjectMolecular analysispt_PT
dc.subjectPancreatic cystspt_PT
dc.titleGenetic testing vs microforceps biopsy in pancreatic cysts: Systematic review and meta-analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage3467pt_PT
oaire.citation.issue26pt_PT
oaire.citation.startPage3450pt_PT
oaire.citation.titleWorld Journal of Gastroenterologypt_PT
oaire.citation.volume25pt_PT
person.familyNameFaias
person.familyNamePereira
person.familyNameSantos Luís
person.familyNameChaves
person.familyNameCravo
person.givenNameSandra
person.givenNameLuísa
person.givenNameÂngelo Filipe
person.givenNamePaula
person.givenNameMarília
person.identifier.ciencia-idF415-64BA-F514
person.identifier.ciencia-id4F15-1868-D001
person.identifier.ciencia-id3D14-798B-65D3
person.identifier.orcid0000-0002-3358-7288
person.identifier.orcid0000-0002-9068-4607
person.identifier.orcid0000-0003-0712-6522
person.identifier.orcid0000-0002-0732-2059
person.identifier.orcid0000-0001-8309-4599
person.identifier.scopus-author-id6504523901
person.identifier.scopus-author-id10839238300
person.identifier.scopus-author-id7003558877
person.identifier.scopus-author-id35551480200
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicatione72fb3b6-e1fa-4cd7-bbd8-675b810829ca
relation.isAuthorOfPublication604e508e-9f4e-4950-b2a4-1b06c7192afe
relation.isAuthorOfPublicationa2d7c872-99db-41e1-9bc9-82c2d47b4661
relation.isAuthorOfPublication12dd83fa-2f05-418b-8225-25399f2548e1
relation.isAuthorOfPublicationd371b63d-92a6-4771-8b4a-913567d1c9d2
relation.isAuthorOfPublication.latestForDiscovery12dd83fa-2f05-418b-8225-25399f2548e1

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