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

Abstract

Background The purpose of this study was to clarify the role of cytology when using endoscopic ultrasound‐guided fine needle aspiration or biopsy (EUS‐FNA/FNB) for pancreatic lesions by comparison with histology, and also to examine differences in diagnostic accuracy depending on the puncture route and sample acquisition method. Methods We studied 146 cases in which cytology and histology were performed when undertaking pancreatic EUS‐FNA/FNB and the final histological diagnosis was obtained from surgically resected samples. Cytological, histological, and combined diagnoses with cytology and histology (combined diagnosis) detected malignant including suspected malignancy, indeterminate, and benign lesions. Results The accuracy of both cytology and histology in pancreatic EUS‐FNA/FNB was 80.1%, with the combined diagnosis having an improved accuracy of 88.4%. The accuracy obtained with cytology was 80.0% for trans‐duodenal puncture samples and 80.3% for trans‐gastric puncture samples, with no difference between them. By contrast, the accuracy obtained with histology was 76.5% for trans‐duodenal samples and 85.2% for trans‐gastric samples, and they differed depending on the puncture route. The cytology accuracy was 80.9% for FNA and 79.8% for FNB, while the histology accuracy was 72.3% for FNA and 83.8% for FNB. Conclusions Combining cytological diagnosis with histological diagnosis improved the diagnostic accuracy of EUS‐FNA/FNB. Compared with histological diagnosis, cytological diagnosis showed stable diagnostic accuracy without being affected by differences in the puncture route or sample acquisition method.

Small biopsies for pancreatic lesions: Is there still room for fine needle aspiration?

“…Accuracy provided by both methods was also satisfactory – 89.5% (±11.7; 63.0–100.0) for FNA and in the FNB group 90.8% (±7.1; 77.0–100.0)—again with no statistical difference (Figure 2). These data show no superiority of FNB over FNA in terms of diagnosis capability, finding consistent with other studies in the literature 9,10,35 . As a matter of fact, studies that compared FNA in association with FNB to FNA or FNB alone concluded that the association of both methods held better diagnostic yield and accuracy than any of the isolated techniques 18,35 .…”

“…These data show no superiority of FNB over FNA in terms of diagnosis capability, finding consistent with other studies in the literature 9,10,35 . As a matter of fact, studies that compared FNA in association with FNB to FNA or FNB alone concluded that the association of both methods held better diagnostic yield and accuracy than any of the isolated techniques 18,35 . This is probably explained by the distinct type of information provided by cytology and histology, empowered when combined (Figure 3).…”