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

Abstract

Objective A meta-analysis has not been previously performed to evaluate critically the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solely pancreatic ductal adenocarcinoma and address factors that have an impact on variability of accuracy. The aim of this study was to determine whether the presence of a cytopathologist, variability of the reference standard and other sources of heterogeneity significantly impacts diagnostic accuracy. Methods We conducted a comprehensive search to identify studies, in which the pooled sensitivity, specificity, likelihood ratios for a positive or negative test (LR+, LR−) and summary receiver-operating curves (SROC) could be determined for EUS-FNA of the pancreas for ductal adenocarcinoma using clinical follow-up, and/or surgical biopsy or excision as the reference standard. Results We included 34 distinct studies (3644 patients) in which EUS-FNA for a solid pancreatic mass was evaluated. The pooled sensitivity and specificity for EUS-FNA for pancreatic ductal adenocarcinoma was 88.6% [95% confidence interval (CI): 87.2–89.9] and 99.3% (95% CI: 98.7–99.7), respectively. The LR+ and LR− were 33.46 (95% CI: 20.76–53.91) and 0.11 (95% CI: 0.08–0.16), respectively. The meta-regression model showed rapid on-site evaluation (ROSE) (P = 0.001) remained a significant determinant of EUS-FNA accuracy after correcting for study population number and reference standard. Conclusion EUS-FNA is an effective modality for diagnosing pancreatic ductal adencarcinoma in solid pancreatic lesions, with an increased diagnostic accuracy when using on-site cytopathology evaluation.

Ultrasound-guided percutaneous fine-needle aspiration of solid pancreatic neoplasms: 10-year experience with more than 2,000 cases and a review of the literature

“…The largest published meta-analyses of EUS-FNA in solid pancreatic lesions showed sensitivity and specificity values of 83-92 % and 94-100 %, respectively [10,12,27,28], although the false-negative rate of EUS-FNA can reach as high as 12 % [28][29][30][31][32][33]. Moreover, a randomized controlled trial by Horwhat et al [3] comparing EUS-FNA to CT-/ US-FNA revealed no significant differences between the endoscopic and percutaneous approaches for the diagnosis of malignant pancreatic lesions.…”

“…The many published papers dealing with pancreatic FNA have shown a variable rate of inadequate samples[1,2,12,13], which surpassed 15 % for the percutaneous approach…”

Is It Time to Take a Pass on the Increased Number of Passes in EUS-FNA?

“…Despite numerous studies addressing these issues, many endoscopists are still perplexed about the nature of the best practices needed to ensure optimal results, in particular with regard to the need for on-site cytopathology for skilled and experienced endosonographers practicing at a high-volume center. To date, multiple meta-analyses have confirmed the diagnostic accuracy, cost-effectiveness, accuracy, and safety of EUS-FNA for solid pancreatic lesions [8][9][10][11][12]. Moreover, structured literature reviews have concluded that rapid on-site evaluation (ROSE) improves diagnostic accuracy [8,9].…”

Colangiopancreatografia retrógrada endoscópica versus ecoendoscopia no diagnóstico anatomopatológico da estenose biliar com suspeita de origem maligna: estudo comparativo prospectivo

“…Vários estudos relatam que o ROSE, permitindo avaliar a presença ou não do material adequado 104 , aumenta a acurácia, além de diminuir o número de punções necessárias 102,103 . Em revisão sistemática e metanálise 104 , incluindo 34 estudos e mais de 3600 pacientes, foi comprovada a superioridade do ROSE em relação à EE-PAAF sem presença do citologista em sala.…”

“…Em revisão sistemática e metanálise 104 , incluindo 34 estudos e mais de 3600 pacientes, foi comprovada a superioridade do ROSE em relação à EE-PAAF sem presença do citologista em sala.…”