Abstract
Objective
Endoscopic ultrasound-guided fine-needle aspiration and bile duct brushings are utilized in the cytologic evaluation of solid and cystic pancreaticobiliary tract lesions. We sought to determine the diagnostic accuracy of cytology.
Methods
Five hundred seventy-nine pancreatic resections with 727 corresponding cytology specimens were identified from 1997 to 2012. Histologic diagnoses included benign, carcinoma, pancreatic endocrine neoplasm (PEN), nonepithelial neoplasms, cystic neoplasms, and ampullary adenomas. Standard interpretative categories—nondiagnostic, negative, atypical, suspicious, and positive—were utilized for preoperative cytology specimens.
Results
For solid masses, the sensitivity and specificity of positive fine-needle aspiration (FNA) cytology for detecting carcinoma were 74 and 100 %, respectively. FNAs performed better than brushings (sensitivity, 40 %; specificity, 98 %) in detecting carcinomas. Similar findings were seen for PENs and nonepithelial neoplasms. For cystic lesions, the sensitivity of FNA for predicting malignancy was lower (24 %) with a specificity of 97 %. Sequentially combining suspicious and atypical categories with the positive category resulted in increases in sensitivity and decreases in specificity for all cases except for cystic lesions.
Conclusions
Cytology adds to the assessment of solid masses, but its utility in cystic lesions is less clear. Consideration of a suspicious cytologic interpretation as a positive diagnosis for triaging patients to surgery is supported by our study.
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References
Al-Haddad M, Eloubeidi MA. Interventional EUS for the diagnosis and treatment of locally advanced pancreatic cancer. JOP 2010;11(1):1-7.
Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012;75(2): 319-331.
Brugge WR. The use of EUS to diagnose cystic neoplasms of the pancreas. Gastrointest Endosc 2009;69(2 Suppl): S203-S209.
Turner BG, Brugge WR. Diagnostic and therapeutic endoscopic approaches to intraductal papillary mucinous neoplasm. World J Gastrointest Surg 2010;2(10): 337-341.
Thosani N, Thosani S, Qiao W, Fleming JB, Bhutani MS, Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Dig Dis Sci 2010;55(10): 2756-2766.
Pitman MB, Genevay M, Yaeger K, Chebib I, Turner BG, Mino-Kenudson M, Brugge WR. High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology. Cancer Cytopathol 2010;118(6):434-440.
Pitman MB, Lewandrowski K, Shen J, Sahani D, Brugge W, Fernandez-del Castillo C. Pancreatic cysts: preoperative diagnosis and clinical management. Cancer Cytopathol 2010;118(1): 1-13.
Layfield LJ, Wax TD, Lee JG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary duct brushings. Acta Cytol 1995;39(1): 11-18.
McGuire DE, Venu RP, Brown RD, Etzhorn KP, Glaws WR, Abu-Hammour A. Brush cytology for pancreatic carcinoma: an analysis of factors influencing results. Gastrointest Endosc 1996;44(3): 300-304.
Ryan ME. Cytologic brushings of ductal lesions during ERCP. Gastrointest Endosc 1991; 37(2): 139-142.
**g X, Wamsteker EJ, Li H, Pu RT. Combining fine needle aspiration with brushing cytology has improved yields in diagnosing pancreatic ductal adenocarcinoma. Diagn Cytopathol 2009;37(8):574-578.
Lachter JY, Rosenthal Y, Kluger Y. A multidisciplinary survey on controversies in the use of EUS-guided FNA: assessing perspectives of surgeons, oncologists and gastroenterologists. BMC Gastroenterol 2011;11(117):1-9.
Afify AM, al-Khafaji BM, Kim B, Scheiman JM. Endoscopic ultrasound-guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy. Acta Cytol 2003; 47(3): 341-348.
Basir A, Pello N, Dayer AM, Shidham VB, Komorowski RA. Accuracy of cytologic interpretation of pancreatic neoplasms by fine needle aspiration and pancreatic duct brushings. Acta Cytol 2003;47(5): 733-738.
Eloubeidi MA, Jhala D, Chhieng DC, Chen VK, Eltoum I, Vickers S, Mel Wilcox C, Jhala N. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer 2003;99(5): 285-292.
Mitsuhashi T, Ghafari S, Chang CY, Gu M. Endoscopic ultrasound-guided fine needle aspiration of the pancreas: cytomorphological evaluation with emphasis on adequacy assessment, diagnostic criteria and contamination from the gastrointestinal tract. Cytopathology 2006;17(1):34-41.
Shin HJ, Lahoti S, Sneige N. Endoscopic ultrasound-guided fine-needle aspiration in 179 cases: the M. D. Anderson Cancer Center experience. Cancer 2002;96(3): 174-180.
Volmar KE, Vollmer RT, Routbort MJ, Creager AJ. Pancreatic and bile duct brushing cytology in 1000 cases: review of findings and comparison of preparation methods. Cancer 2006;108(4): 231-238.
Petrone MC, Arcidiacono PG. Role of endosocopic ultrasound in the diagnosis of cystic tumours of the pancreas. Dig Liver Dis 2008;40(11): 847-853.
Kimura W. How many millimeters do atypical epithelia of the pancreas spread intraductally before beginning to infiltrate? Hepatogastroenterology 2003. 50(54): 2218-2224.
Aithal GP, Chen RY, Cunningham JT, Durkalski V, Kim EY, Patel RS, Wallace MB, Hawes RH, Hoffman BJ. Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas. Gastrointest Endosc 2002;56(5): 701-707.
Pais SA, Attasaranya S, Leblanc JK, Sherman S, Schmidt CM, DeWitt J. Role of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms: correlation with surgical histopathology. Clin Gastroenterol Hepatol 2007;5(4):489-495.
Yamao K, Nakamura T, Suzuki T, Sawaki A, Hara K, Kato T, Okubo K, Matsumoto K, Shimizu Y. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10(2): 142-146.
Sedlack R, Affi A, Vazquez-Sequeiros E, Norton ID, Clain JE, Wiersema MJ. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc 2002;56(4): 543-547.
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, Yamao K, Matsuno S. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6(1-2): 17-32.
Wilson JL, Kalade A, Prasad S, Cade R, Thomson B, Banting A, Mackay S, Desmond PV, Chen RY. Diagnosis of solid pancreatic masses by endoscopic ultrasound-guided fine-needle aspiration. Intern Med J 2009;39(1):32-37.
Turner BG, Cizginer S, Agarwal D, Yang J, Pitman MB, Brugge WR. Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc 2010; 71(1):91-98.
Zhang S, Defrias DV, Alasadi R, Nayar R. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA): experience of an academic centre in the USA. Cytopathology 2010;21(1):35-43.
Yusuf TE, Ho S, Pavey DA, Michael H, Gress FG. Retrospective analysis of the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic masses, using a 22-gauge or 25-gauge needle system: a multicenter experience. Endoscopy 2009;41(5):445-448.
Ardengh JC, Lopes CV, Campos AD, Pereira de Lima LF, Venco F, Modena JL. Endoscopic ultrasound and fine needle aspiration in chronic pancreatitis: differential diagnosis between pseudotumoral masses and pancreatic cancer. JOP 2007;8(4): 413-421.
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, del Castillo CF, Warshaw AL. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126(5):1330-1336.
Frossard JL, Amouyal P, Amouyal G, Palazzo L, Amaris J, Soldan M, Giostra E, Spahr L, Hadengue A, Fabre M. Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions. Am J Gastroenterol 2003;98(7): 1516-1524.
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Pang, J.C., Minter, R.M., Kwon, R.S. et al. The Role of Cytology in the Preoperative Assessment and Management of Patients with Pancreaticobiliary Tract Neoplasms. J Gastrointest Surg 17, 501–510 (2013). https://doi.org/10.1007/s11605-012-2133-x
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DOI: https://doi.org/10.1007/s11605-012-2133-x