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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 15, 2019
Accepted:
October 24,
2019
Received:
May 8,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
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Access this article on ScienceDirectLinked Article
- Optimal EUS-guided FNA cytology preparation when rapid on-site evaluation is not availableGastrointestinal EndoscopyVol. 91Issue 4
- PreviewPancreatic 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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