Fine-needle aspiration cytology for neck lesions in patients with antithrombotic/anticoagulant medications: systematic review and meta-analysis

초록

Objectives This systematic review and meta-analysis aimed to determine the true risk of bleeding and nondiagnostic (ND) specimens associated with fine-needle aspiration cytology (FNAC) for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications. MethodsUsing the Population Intervention Comparison and Outcome modeling, we searched PubMed and Google Scholar databases to identify studies published between January 2000 and March 2023 reporting the safety and sample adequacy of FNAC for neck lesions in patients taking AT/AC medications. The pooled incidences of bleeding and ND specimens and pooled risk ratio (RR) with 95% confidence intervals (CIs) obtained using a fixed-effects model were compared for patients continuing AT/AC (AT/AC group) and patients not receiving AT/AC therapy (no-AT/AC group). Results We included six original articles involving a total of 3014 patients. The pooled incidence of bleeding was 0.9% (95% CI, 0.344-2.026) and 0.7% (95% CI, 0.390-1.146) in the AT/AC and no-AT/AC groups, respectively. The pooled RR under the fixed-effects model was 1.39 (95% CI, 0.56-3.44) with no evidence of between-study heterogeneity (I-2 = 0.0%; p = 0.92). The pooled incidence of ND specimens was 7.6% (95% CI, 5.617-10.073) and 7.6% (95% CI, 6.511-8.752) in the AT/AC and no-AT/AC groups, respectively. The pooled RR under the fixed-effects model was 1.33 (95% CI, 0.98-1.81) with moderate between-study heterogeneity (I-2 = 60.0%; p = 0.06). Conclusions The AT/AC medication is not associated with increased risk of bleeding or ND specimens in FNAC for neck lesions. Therefore, interruption of the AT/AC medication is not recommended before FNAC even in patients taking AT/AC medications. Clinical relevance statement This study is the first meta-analysis evaluating risk of bleeding and nondiagnostic specimens associated with fine-needle cytology for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications. This suggests withholding AT/AC medications is not mandatory for safe and diagnostic FNACs.

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