C0445 - Diagnostic Accuracy of Endoscopic Ultrasound (EUS)-Guided Fine Needle Biopsy (FNB) by Macroscopic On-Site Evaluation (MOSE): A Systematic Review and Meta-Analysis

Introduction: Assessment of endoscopic ultrasound (EUS) guided fine needle tissue adequacy by macroscopic on-site evaluation (MOSE) is gathering attention. Studies report good diagnostic parameters with MOSE; however, the overall data is limited and it is unknown if MOSE is as good as rapid on-site evaluation (ROSE). We conducted this systematic review and meta-analysis to report on the pooled diagnostic parameters of EUS-guided tissue acquisition by MOSE using fine needle biopsy (FNB).

Methods: Major databases like Medline, Embase, Scopus were searched by experienced medical librarian (Dec 2021), and studies that reported on the diagnostic assessment of EUS-guided tissue acquisition by MOSE were selected. Pooled diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated by standard meta-analysis methods following the random-effects model. Heterogeneity was assessed by I²% statistics.

Results: 14 studies were included in the final analysis. 1508 lesions were biopsied in 1489 patients undergoing EUS-guided tissue acquisition. MOSE definition included a visible core of tissue with opacity, ‘worm-like’ features of adequate size and length (>4mm). Majority of the lesions biopsied were solid pancreatic masses (692 lesions, 45.8%), followed by lymph nodes (n=334, 22.1%), submucosal tumors (n=183, 12.1%), and other extra-pancreatic lesions (n=299, 19.8%).
The pooled accuracy of biopsy specimen in yielding a pathological diagnosis by MOSE was 91.3% (95% CI 88.6-93.3, I²=66%), pooled sensitivity was 91.5% (88.6-93.6, I²=66%), pooled specificity was 98.9% (96.6-99.7, I²=80%), pooled PPV was 98.8% (97.4-99.5, I²=33%), and pooled NPV was 55.5% (46.9-63.9, I²=95%).
The pooled rate of good specimen quality by MOSE as assessed by the endoscopist was 84.9% (60.1-95.4, I²=91%). The pooled rate of diagnostic yield was 93% (87.7-96.1, I²=73%). Adverse events were minimal (2.5%, 1.5-3.9, I²=21%). Subgroup analysis by needle type is summarized in Table-1.

Discussion: Based on a meta-analysis of 14 studies, EUS-guided tissue acquisition with MOSE demonstrated excellent pooled diagnostic accuracy, sensitivity, specificity and PPV. Criteria of MOSE must include a visible core of tissue with opacity, ‘worm-like’ features of adequate size and length (>4mm). In centers with access to ROSE, future well-controlled studies are warranted to establish the outcomes of MOSE in comparison to ROSE, especially with the newer generation EUS specific biopsy needles.