Comparison of liquid-based cytology with conventional smear cytology for EUS-guided FNA of solid pancreatic masses: a prospective randomized noninferiority study

Abstract

Background and Aims: 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).Methods: 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 À10% was assumed.Results: 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 Z .276), 87.7% versus 83.2% (P Z .256), 100% versus 100% (P Z .999), 100% versus 100% (P Z .999), and 16.7% versus 16.1% (P Z .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.Conclusions: 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.) (Gastrointest Endosc 2020;91:837-46.)

Comparison of EUS-guided conventional smear and liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

“…From an initial pool of 756 studies, 454 records were screened and 48 full-length articles were assessed. A total of nine studies (including 1308 patients) were included in the final analysis 18 32 33 34 35 36 37 38 39 . None of the included studies used ROSE.…”

“…Four studies originated in Korea, two in China, and one each from the Netherlands, the United States, and Japan. Three studies used the precipitation-based technique of LBC 32 33 34 whereas six used the filtration-based technique (five studies used ThinPrep ® and one used CellPrep ® 18 ). The schematic diagram demonstrating our study selection is shown in Supplementary Fig.…”

“…Six studies were prospective in design, 18 23 32 35 39 40 and the remaining were retrospective. The detailed study quality evaluation is presented in Supplementary Table 1 .…”

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions

“…LBC can eliminate unnecessary background inflammatory and blood cells to increase diagnostic accuracy. Recent studies reported that LBC showed similar results to conventional smear for diagnosis of pancreatic masses [3,4]. The use of LBC may be limited for mucinous neoplasms because mucin is more dilute and scant on LBC preparations.…”

Thinprep® test versus conventional smear for the detection of pancreatic neoplasms after percutaneous ultrasound-guided fine-needle aspiration biopsy

“…signi cantly greater than those of CS (P < 0.0001), and the sensitivity and accuracy of both CS and TCT were signi cantly greater than those of TCT or CS based on the three cases (P < 0.0001). [15,16]. In LBC, the cytological features of malignancy are retained and enhanced in a smaller screening area, which enhances accuracy in detection of malignant cells.…”