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TOPLINE
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) achieved 79% diagnostic accuracy for autoimmune pancreatitis (AIP), and newer Franseen and Fork-tip needles performed better than older bevel-type needles. The procedure obtained adequate tissue samples in 97% of cases and contributed to definitive diagnosis in 69% of patients when other diagnostic modalities were inconclusive.
METHODOLOGY
- A systematic review and meta-analysis included 16 studies (one randomized controlled trial, four prospective studies, and 11 retrospective studies) evaluating EUS-FNB for tissue sampling in patients with AIP.
- The analysis encompassed 732 patients, predominantly with type 1 AIP, from studies conducted in Japan, China, South Korea, Italy, the United Kingdom, and Denmark.
- Researchers assessed diagnostic accuracy, sample adequacy, contribution to AIP diagnosis when other methods were inconclusive, and adverse events associated with the procedure.
- Various needle types were evaluated, including Franseen needles, Fork-tip needles, and reverse/forward-bevel needles of different gauges (19G, 20G, 22G).
- Diagnosis of AIP was based on the International Consensus Diagnostic Criteria, requiring specific histological features such as lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and IgG4-positive plasma cells.
TAKEAWAY
- The pooled diagnostic accuracy of EUS-FNB for AIP was 79%.
- Diagnostic performance varied by needle type:Franseen needle achieved 83% diagnostic accuracy, and the Fork-tip needle achieved 90% accuracy, both significantly outperforming reverse/forward-bevel needles at 51% accuracy (all P <.001).
- The 22-gauge needle had higher diagnostic accuracy than 19-gauge/20-gauge needles (85% vs 70%; P <.001).
- Level 1 histological criteria were achieved in 49% of cases, while Level 2 criteria were met in 30%.
- EUS-FNB contributed to diagnosis in 69% of cases. The sample adequacy was 97%, and adverse events occurred in 4%.
IN PRACTICE
"The available evidence suggests that EUS-FNB can provide adequate histological samples with satisfactory diagnostic accuracy in patients with AIP, while maintaining a low rate of adverse events. It is particularly valuable in cases where imaging findings, serological markers, and evidence of involvement of other organs are insufficient for diagnosis," the authors wrote.
SOURCE
The study was led by Huiling Yu, Jingwei Kou, the Affiliated Hospital of Hebei University in Baoding, China, and Qijin He, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China. It was published online on July 25, 2026, in BMC Gastroenterology.
LIMITATIONS
Most included studies focused on type 1 AIP, with few type 2 cases, limiting generalizability. Few non-AIP controls reduced assessment of true negative results, and some studies may have reported sensitivity rather than true accuracy. The long study period introduced variability in endoscopic technique and pathology review. In addition, head-to-head comparative studies of biopsy needle types were limited.
DISCLOSURES
The study was supported by grants from the S&T Program of Baoding and the Excellent Clinical Medicine Talents Program Funded by the People's Government of Hebei Province. The authors reported no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
