Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasound-guided fine needle aspiration

doi:10.1016/S1499-3872(17)60035-3

Hepatobiliary & Pancreatic Diseases International

Volume 16, Issue 4, 15 August 2017, Pages 418-423

https://doi.org/10.1016/S1499-3872(17)60035-3 Get rights and content

Background

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has become a crucial diagnostic technique for pancreatic malignancies. The specimen obtained by EUS-FNA can be prepared for either cytological or histological examinations. This study was to compare diagnostic performance of cytological and histological preparations using EUS-FNA in the same lesions when pancreatic malignancies were suspected.

Methods

One hundred and eighteen patients who underwent EUS-FNA for suspected pancreatic malignancies were consecutively enrolled. All procedures were conducted by a single echoendoscopist under the same conditions. Four adequate preparations were obtained by 22-gauge needles with 20 to-and-fro movements for each pass. The 4 preparations included 2 cytological and 2 histological specimens. The pathologic reviews of all specimens were conducted independently by a single experienced cytopathologist. Sensitivity, specificity, and accuracy of the 2 preparations were compared.

Results

The enrolled patients consisted of 62 males (52.5%), with the mean age of 64.6±10.5 years. Surgery was performed in 23 (19.5%) patients. One hundred and sixteen (98.3%) lesions were classified as malignant, while 2 (1.7%) were benign. Sensitivity of cytology and histology were 87.9% and 81.9%, respectively, with no significant difference (P=0.190). Accuracy was also not significantly different. Cytological preparation was more sensitive when the size of lesion was <3 cm (86.7% vs 68.9%, P=0.033).

Conclusions

Our results suggested that the diagnostic performances of cytological and histological preparations are not significantly different for the diagnosis of pancreatic malignancies. However, cytological preparation might be more sensitive for pancreatic lesions <3 cm.

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Cited by (6)

Comparison of liquid-based cytology with conventional smear cytology for EUS-guided FNA of solid pancreatic masses: a prospective randomized noninferiority study
2020, Gastrointestinal Endoscopy
Citation Excerpt :
With regard to the procedure for smear preparation, EUS-FNA smear slides in our institution are prepared by an experienced endoscopy nurse who has performed more than 100 cases annually under the endoscopists’ supervision. A previous study on the diagnostic performance of CSs prepared by the endoscopy nurse at this institution demonstrated a sensitivity of 87.9% and accuracy of 88.1%, which are similar to the present study and several previous studies.17,19,30 Finally, the cost difference between the 2 methods was not assessed in this study.
There are limited data on the efficacy of liquid-based cytology (LBC) for EUS-guided FNA specimens. We aimed to evaluate the diagnostic efficacy of LBC for solid pancreatic neoplasms compared with conventional smears (CSs).
In this randomized, crossover, noninferiority trial, we randomly assigned (1:1) patients with suspected pancreatic cancer to the LBC group or the CS group. Aspirates from the first needle pass were processed by one method, aspirates from the second pass by the other method, and specimens from the last pass were processed as core biopsy samples. The primary endpoint was the diagnostic efficacy of each method, with the final diagnosis as the gold standard. A noninferiority margin of −10% was assumed.
Of 170 randomized patients, 165 were classified as malignant and 5 as benign. Unsatisfactory samples were less frequent in the LBC group (1.78%) compared with the CS group (5.33%). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of LBC versus CS were 88.0% versus 83.8% (P = .276), 87.7% versus 83.2% (P = .256), 100% versus 100% (P = .999), 100% versus 100% (P = .999), and 16.7% versus 16.1% (P = .953), respectively. A bloody background was significantly more frequent in the CS group (CS, 85.2%; LBC, 1.8%; P < .001), whereas the nuclear features were similar for both groups.
The diagnostic usefulness of LBC was comparable with that of CS. The cytomorphologic features did not differ significantly between the 2 methods, and the reduced bloody backgrounds allowed better visibility in the LBC method. (Clinical trial registration number: NCT03606148.)
Ultrasound-guided fine-needle aspiration cytology for pancreatic neoplasms: diagnostic accuracy and effects on clinical decision-making
2023, Research Square
Usefulness of cytological diagnosis in pancreatic endoscopic ultrasound-guided fine needle aspiration or biopsy: Comparison with histological diagnosis and relationship with puncture route and sample acquisition method
2023, Diagnostic Cytopathology
Intermittent endoscopic ultrasound guided fine-needle aspiration for the diagnosis of solid pancreatic lesions. A pilot study
2022, Revista Espanola de Enfermedades Digestivas
Comparison between conventional smear and liquid-based preparation in endoscopic ultrasonography-fine needle aspiration cytology of pancreatic lesions
2020, Diagnostics
Evaluation of Percutaneous Ultrasound-guided Biopsy for Pancreatic Neoplasms: A Case-control Study
2020, Medical Journal of Peking Union Medical College Hospital

Published online June 30, 2017.

Contributors: LSH proposed the study. JDK and LSH performed the research and wrote the first draft. LKB performed independent pathological reviews. CKH, LBS, SJH and LJW collected the data. LJK, PWH, RJK and KYT analyzed the data. All authors contributed to the design and interpretation of the study. LSH is the guarantor.

Funding: None.

Ethical approval: This study was approved by the Institutional Ethics Review Board of Seoul National University Hospital and conducted in accordance with the Declaration of Helsinki (IRB No. 1505-033-670).

Competing interest: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Original Article/PancreasComparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasound-guided fine needle aspiration

Background

Methods

Results

Conclusions

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Gastrointest Endosc

Hepatobiliary Pancreat Dis Int

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Endoscopy

The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia

Gastrointest Endosc

Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: a review

Cancer Cytopathol

Endoscopic ultrasound-guided pancreatic fine-needle aspiration: potential pitfalls in one institution's experience of 1212 procedures

Cancer Cytopathol

Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: performance and outcomes

J Gastroenterol Hepatol

Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions

Endoscopy

Endoscopic ultrasound-guided fine needle aspiration: from the past to the future

Endosc Ultrasound

The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis

Cytopathology

Original Article/Pancreas
Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasound-guided fine needle aspiration