title: Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: a systematic review and meta-analysis.
abstract: BACKGROUND
  Several recent studies have investigated the utility of 19-, 22-, and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic and peri-pancreatic tumors.
  
  
  OBJECTIVE
  The objective of this study was to summarize data from these studies and estimate the effect of needle size on reported outcomes such as accuracy, adequacy, and complications.
  
  
  METHODS
  Systematic review and meta-analysis comparing the effect of needle size (19, 22, and 25G) on diagnostic accuracy, adequacy, number of needle passes, and complications.
  
  
  RESULTS
  25G appear to confer an advantage in adequacy rates relative to 22G needles (risk difference = 0.12 %, 95 % CI 0.01, 0.25). There was no significant difference in accuracy with an overall sensitivity and specificity for 22G being 0.78 (95 % CI 0.74-0.81) and 1.00 (95 % CI 0.98-1.00) and an overall sensitivity and specificity for 25G being 0.91 (95 % CI 0.87-0.94) and 1.00 (95 % CI 0.97-1.00). There was no difference in number of passes or complications between 25 and 22G. The limited data available regarding 19G needles do not show evidence of improved outcomes with these devices.
  
  
  CONCLUSIONS
  In the evaluation of pancreatic and peri-pancreatic lesions by EUS-FNA, 25G needles may confer an advantage in adequacy relative to 22G needles but confer no advantages with respect to accuracy, number of passes, or complications.
authors.affiliation: Department of Pathology, School of Medicine and ARUP Laboratories, University of Utah, Salt Lake City, UT, USA.
authors.forename: Kajsa E
authors.initials: KE
authors.lastname: Affolter
authors.forename: Robert L
authors.initials: RL
authors.lastname: Schmidt
authors.forename: Anna P
authors.initials: AP
authors.lastname: Matynia
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Factor
mesh_terms: D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation*; D019160:Endosonography; D006801:Humans; D009339:Needles; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*