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Comparison of smear cytology and liquid-based cytology in EUS-guided FNA of pancreatic lesions: experience from a large tertiary center

  • Author Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    Wei Zhou
    Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Author Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    Li Gao
    Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    Affiliations
    Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Author Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    Shi-min Wang
    Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    Affiliations
    Medical College of Nantong University, Nantong, China
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  • Feng Li
    Affiliations
    Department of Gastroenterology, Christus Trinity Clinic and Hospital, Tyler, Texas, USA
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  • Jun Li
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Shi-yu Li
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Peng Wang
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Fang-zhou Jia
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Jia-jia Xu
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Author Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Chun-hua Zhou
    Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Author Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Duo-wu Zou
    Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

    Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Author Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Zhen-dong Jin
    Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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  • Author Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Kai-xuan Wang
    Correspondence
    Reprint requests: Kaixuan Wang, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Second Military Medical University, Shanghai 200433, China.
    Footnotes
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
    Affiliations
    Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Zhou and Gao and Ms Wang contributed equally to this article.
    † Drs Wang, Jin, and Zou shared co-corresponding authorship.
Published:November 15, 2019DOI:https://doi.org/10.1016/j.gie.2019.10.033

      Background and Aims

      Studies comparing the diagnostic efficacy of liquid-based cytology (LBC) and smear cytology (SC) of pancreatic tissue sampling obtained via EUS-guided FNA (EUS-FNA) are still insufficient, mainly because results were controversial. We compared the diagnostic efficiency of LBC and SC of EUS-FNA of pancreatic lesions in one of the largest tertiary hospitals in China.

      Methods

      A retrospective database search (January 2015 to January 2019) was performed for patients who underwent EUS-FNA with both LBC and SC. Demographic, cytologic, and endosonographic data were collected from 819 patients; 514 cases met the inclusion criteria. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were compared. Rapid on-site evaluation was not available in all cases.

      Results

      Three hundred eighty-five cases (74.90%) had confirmed malignancy, and 40 cases (7.78%) confirmed benign neoplasm. Adequate tissue sampling rates showed no significant difference between the 2 groups. The sensitivity, accuracy, and negative predictive value (NPV) of LBC were higher than those of SC with statistical significance (71.4% vs 55.1%, 76.1% vs 61.6%, and 40.6% vs 27.7%, respectively). The sensitivity, accuracy, and NPV of combined SC and LBC were higher than those of LBC alone with statistical significance (83.9% vs 71.4%, 86.5% vs 76.1%, and 56.8% vs 40.6%, respectively). Multivariate analysis revealed that pancreatic neck/body/tail lesions (P = .003), solid lesions (P < .001), 22-gauge needle size (P < .001), and number of needle passage >3 (P = .041) were associated with higher diagnostic sensitivity in all participants using LBC, whereas number of needle passage >3 (P = .017) was associated with higher diagnostic sensitivity using SC.

      Conclusions

      LBC was more accurate and sensitive than SC in EUS-FNA of pancreatic lesions with higher NPV when rapid on-site evaluation is unavailable. Pancreatic neck/body/tail lesions, solid lesions, 22-gauge needle, and more than 3 passes were associated with higher sensitivity when using LBC. Performing more than 3 passes is associated with higher sensitivity when using SC.

      Abbreviations:

      IPMN (intraductal papillary mucinous neoplasm), LBC (liquid-based cytology), NPV (negative predictive value), OR (odds ratio), PanNET (pancreatic neuroendocrine tumor), PSC (Papanicolaou Society of Cytopathology), SC (smear cytology), SPN (solid pseudopapillary neoplasm)
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      Linked Article

      • Optimal EUS-guided FNA cytology preparation when rapid on-site evaluation is not available
        Gastrointestinal EndoscopyVol. 91Issue 4
        • Preview
          Pancreatic adenocarcinoma is the fourth leading cause of cancer mortality in the United States, and its incidence is rising.1 EUS with FNA (EUS-FNA) has become the main technique for evaluating pancreatobiliary disorders, especially pancreatic neoplasia.2 Many patients with pancreatic cancer present at an advanced stage requiring systemic treatment. Accurate and definitive diagnosis is required before that treatment.
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