A Prospective Comparison of Liquid-Based Cytology and Traditional Smear Cytology in Pancreatic Endoscopic Ultrasound-Guided Fine Needle Aspiration

Abstract

Objective: To compare results of liquid-based cytology (LBC) and the conventional smear method (SMEAR) when performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for lesions of suspected pancreatic malignancy without an on-site cytopathologist. Study Design: Fifty-eight patients were prospectively enrolled between July and December 2009. Aspirates obtained from the first needle pass were randomized either to SMEAR or LBC. Another sample from the second needle pass was allocated to the other method. The rest of the aspirates from the third or later needle passes were used for SMEAR. Diagnostic accuracy was compared and related factors were pursued. Results: Although both methods were 100% specific, LBC was inferior to SMEAR in terms of sensitivity, negative predictive value, and accuracy. However, LBC provided correct diagnoses in 2 out of 3 cases of false negatives for malignancy by SMEAR in which blood was highly contaminated. Although no factor was identified for LBC, low blood contamination and more than 3 needle passes were related with accurate diagnosis in SMEAR. Conclusion: LBC was less accurate than SMEAR when performing pancreatic EUS-FNA without an on-site cytopathologist. However, LBC might serve as a good complement to SMEAR if blood contamination is profound.

Diagnostic Efficacy of Cell Block Immunohistochemistry, Smear Cytology, and Liquid-Based Cytology in Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions: A Single-Institution Experience

“…LeBlanc et al [24] reported that LBC was inferior to SC for the detection of pancreatic malignancy in a study that employed an on-site cytopathologist during the EUS-FNA procedure. In addition, a prospective study found that LBC was less accurate than SC after EUS-FNA in patients with pancreatic malignancy [8]. We found that the diagnostic efficacy of LBC was relatively higher than that of SC.…”

“…Cytological results from all methods were reported as follows: (1) definite malignancy, (2) suspicion of malignancy, (3) benign cytology, (4) inadequate for diagnosis. Patients were stratified to the “malignancy” group when their results were either (1) definite malignancy or (2) suspicion of malignancy [8].…”

Endoscopic ultrasound‐guided fine needle aspiration with liquid‐based cytology preparation in the diagnosis of metastatic small‐cell carcinoma in the pancreas

“…With regard to diagnosis of pancreatic malignancy via EUS‐FNA, the superiority of LBC over CS with or without ROSE is yet to be fully established . However, several reports have shown the efficacy of EUS‐FNA with LBC .…”

“…Endoscopic ultrasound-guided fine needle aspiration was performed for the large mass using 22 Gauge FNA needle (arrow) With regard to diagnosis of pancreatic malignancy via EUS-FNA, the superiority of LBC over CS with or without ROSE is yet to be fully established. 15,16 However, several reports have shown the efficacy of EUS-FNA with LBC. 8,17 Furthermore, Rossi et al also demonstrated that LBC preparation of EUS-FNA specimens can be useful even in primary pancreatic lymphoma.…”

Current status on the diagnosis and evaluation of pancreatic tumor in Asia with particular emphasis on the role of endoscopic ultrasound

“…Onsite pathologist is probably the most important factor determining the success of EUS‐FNA result . Regarding tissue preparation, liquid‐base cytology is thought to be better than conventional smear method; however, a recent prospective study from Korea showed that the former was less accurate . Another large recent study also confirmed higher accuracy rate of conventional smear compared with ThinPrep method, at 98% versus 64%, respectively …”