# A 22-G or a 25-G Needle: Which One to Use in the Diagnostics of Solid Pancreatic Lesions? A Systematic Review and Meta-Analysis

## TL;DR

This study compares the effectiveness of 22-G and 25-G needles for diagnosing pancreatic cancer through biopsies and finds both are equally safe and effective.

## Contribution

The study provides a systematic review and meta-analysis comparing two commonly used needle sizes for pancreatic lesion biopsies.

## Key findings

- 22-G and 25-G needles show equivalent safety and efficacy in diagnosing solid pancreatic lesions.
- Both needle sizes have high accuracy, sensitivity, and specificity without significant complication risks.

## Abstract

Most cases of pancreatic cancer are diagnosed at an advanced stage, where a significant dissemination of the tumor is present. Many patients with locally progressed cancer were subjected to neoadjuvant therapy. To qualify for such treatment, a diagnosis of cancer had to be confirmed. We performed a comparative analysis of two needles of different sizes which are most frequently used in endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA). Fourteen randomized controlled clinical trials were investigated. The outcomes of our meta-analysis revealed that 22-gauge (G) and 25-G needles are of equivalent safety and efficacy as proved by their high accuracy, sensitivity, and specificity in focal pancreatic lesion biopsy acquisition, while not possessing a high risk of biopsy-related complications.

With the 12th highest incidence and a common late diagnostic at advanced stages, neoadjuvant therapies for pancreatic cancer are important, but they require a confirmed diagnosis. Being a diagnostic standard, the clarification of the clinical relevance of needle gauges is needed, as larger ones may retrieve more tissue for diagnostics, but may also increase the risk of complications. We performed a meta-analysis to compare the efficiency of the most commonly used 22-G and 25-G needles for EUS guided biopsy in solid pancreatic lesions. The MEDLINE (via PubMed), Embase, Cochrane (CENTRAL), and Scopus databases were searched with “EUS”, “needle”, “FNA”, “pancreas”, “prospective”, “22G”, and “25G” keywords. Mixed effects were assessed in the model, with a mean of 86% and a 95% confidence interval. Fourteen prospective studies that compared the efficiency of 22-G and 25-G biopsy needles in 508 and 524 lesions, respectively, were analyzed, along with 332 specimens biopsied using both needle sizes. The groups did not significantly differ in the outcomes. A low degree of heterogeneity was observed overall, except for specimen adequacy. Moreover, 22-G and 25-G needles have comparable safety and efficacy for focal pancreatic lesion biopsies without a high risk of complications.