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Peer-reviewedCC BY 4.0Frontiers in Oncology

Macroscopic versus rapid on-site evaluation for EUS-guided tissue acquisition of solid pancreatic masses: a systematic review, diagnostic test accuracy meta-analysis, and network meta-analysis

  • Huifang Xu1
  • Jiongming He2
  • Gong Chen3
  • Biao Chen3
  1. 1Medical Ultrasound Department, The Second Hospital of Wuhan Iron and Steel (Group) Corp
  2. 2Department of Thoracic and Cardiovascular Surgery, Third Hospital of Wuhan City
  3. 3Cancer Center, Renmin Hospital of Wuhan University
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Abstract

Background: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is central to the pathological diagnosis of solid pancreatic masses, but the comparative value of rapid on-site cytologic evaluation (ROSE), macroscopic on-site evaluation (MOSE), and no on-site evaluation (NONE) may vary by needle type and remains uncertain.

Methods: We performed a PRISMA-DTA systematic review registered in PROSPERO (CRD420251241446). Potential cohort overlap and data dependency were assessed before quantitative synthesis. Diagnostic 2 × 2 data were synthesized with a bivariate binomial-normal random-effects model. Independent direct comparisons were pooled by random-effects meta-analysis for correct versus incorrect diagnosis, with complementary absolute differences in sensitivity and specificity. An exploratory three-node network meta-analysis (NMA) compared ROSE, MOSE, and NONE.

Results: Thirty-one eligible reports contributed 67 strategy-specific diagnostic datasets. After excluding 21 duplicate, nested, paired, or otherwise dependent datasets, 46 independent datasets representing 4,901 arm-level observations were included in the primary DTA. Pooled sensitivity was 0.94 (95% CI 0.92–0.95) and specificity was 1.00 (0.98–1.00); Deeks’ asymmetry test was positive (P <0.001). In direct comparisons, ROSE improved composite diagnostic accuracy versus NONE in FNA studies (OR 5.56, 95% CI 1.76–17.62; k = 4), but not in FNB studies (OR 1.08, 0.42–2.79; k = 4); the FNA-versus-FNB interaction was exploratory (P = 0.012). MOSE versus NONE in FNB was uncertain (OR 1.31, 0.60–2.87; k = 4), as was MOSE versus ROSE (OR 1.53, 0.05–49.13; k = 3). The exploratory NMA did not identify a statistically clear difference for ROSE versus NONE (OR 1.67, 0.94–2.95), MOSE versus NONE (OR 1.89, 0.86–4.20), or MOSE versus ROSE (OR 1.14, 0.48–2.71).

Conclusions: EUS-TA showed high overall diagnostic performance. ROSE may add value in FNA-era workflows, whereas a clear incremental benefit was not detected with FNB. MOSE remains a plausible resource-sparing strategy, but comparative estimates are imprecise. The NMA should be regarded as hypothesis-generating because of sparse comparisons, methodological heterogeneity, small-study effects, and low-to-very-low certainty.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251241446.

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Cite

BibTeXRIS
BibTeX
@article{xu2026macroscopic,
  title = {{Macroscopic versus rapid on-site evaluation for EUS-guided tissue acquisition of solid pancreatic masses: a systematic review, diagnostic test accuracy meta-analysis, and network meta-analysis}},
  author = {Huifang Xu and Jiongming He and Gong Chen and Biao Chen},
  journal = {Frontiers in Oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1943706},
  url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1943706/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Macroscopic versus rapid on-site evaluation for EUS-guided tissue acquisition of solid pancreatic masses: a systematic review, diagnostic test accuracy meta-analysis, and network meta-analysis
AU  - Huifang Xu
AU  - Jiongming He
AU  - Gong Chen
AU  - Biao Chen
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Oncology
DO  - 10.3389/fonc.2026.1943706
UR  - https://www.frontiersin.org/articles/10.3389/fonc.2026.1943706/full
AB  - Background: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is central to the pathological diagnosis of solid pancreatic masses, but the comparative value of rapid on-site cytologic evaluation (ROSE), macroscopic on-site evaluation (MOSE), and no on-site evaluation (NONE) may vary by needle type and remains uncertain.  Methods: We performed a PRISMA-DTA systematic review registered in PROSPERO (CRD420251241446). Potential cohort overlap and data dependency were assessed before quantitative synthesis. Diagnostic 2 × 2 data were synthesized with a bivariate binomial-normal random-effects model. Independent direct comparisons were pooled by random-effects meta-analysis for correct versus incorrect diagnosis, with complementary absolute differences in sensitivity and specificity. An exploratory three-node network meta-analysis (NMA) compared ROSE, MOSE, and NONE.  Results: Thirty-one eligible reports contributed 67 strategy-specific diagnostic datasets. After excluding 21 duplicate, nested, paired, or otherwise dependent datasets, 46 independent datasets representing 4,901 arm-level observations were included in the primary DTA. Pooled sensitivity was 0.94 (95% CI 0.92–0.95) and specificity was 1.00 (0.98–1.00); Deeks’ asymmetry test was positive (P <0.001). In direct comparisons, ROSE improved composite diagnostic accuracy versus NONE in FNA studies (OR 5.56, 95% CI 1.76–17.62; k = 4), but not in FNB studies (OR 1.08, 0.42–2.79; k = 4); the FNA-versus-FNB interaction was exploratory (P = 0.012). MOSE versus NONE in FNB was uncertain (OR 1.31, 0.60–2.87; k = 4), as was MOSE versus ROSE (OR 1.53, 0.05–49.13; k = 3). The exploratory NMA did not identify a statistically clear difference for ROSE versus NONE (OR 1.67, 0.94–2.95), MOSE versus NONE (OR 1.89, 0.86–4.20), or MOSE versus ROSE (OR 1.14, 0.48–2.71).  Conclusions: EUS-TA showed high overall diagnostic performance. ROSE may add value in FNA-era workflows, whereas a clear incremental benefit was not detected with FNB. MOSE remains a plausible resource-sparing strategy, but comparative estimates are imprecise. The NMA should be regarded as hypothesis-generating because of sparse comparisons, methodological heterogeneity, small-study effects, and low-to-very-low certainty.  Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251241446.
SN  - 2234-943X
ER  -