Assessment of preoperative pancreatic biopsy, cytological/histological review of cell‐block‐specimens obtained by endoscopic ultrasound‐guided fine‐needle aspiration: Laboratory‐based study

Abstract

Background Pancreatic cancer is among the most lethal cancers worldwide due to the limited availability of techniques for early detection of signs and symptoms. Reportedly, it is the fourth‐leading cause of cancer‐related mortality among Japanese adults. With the advent of endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) for diagnosing pancreatic cancer, the rate of the cytological and histological diagnoses of cell‐block‐specimens has significantly increased in Japan. Methods The cytological specimens of 165 patients with pancreatic lesions obtained using EUS‐FNA between January 2010 and July 2016 at the Kyorin University Hospital were investigated. The clinical course of 153 patients was assessed from their clinical records, which included information on their imaging diagnosis, laboratory data, final clinical diagnosis and treatment; moreover, the accuracy of the cytological/histological examination and clinical diagnosis at our hospital were analysed. Results The number of cells in cell‐block‐specimens was too small to estimate data. However, cytological specimens were sufficient to observe the findings of suspected malignancy such as necrosis. Biopsy was deemed necessary for diagnosis using both histological and cytological specimens. Conclusion EUS‐FNA can be used not only to diagnose benign or malignant types of pancreatic cancers but also to assess the sensitivity of molecular target drugs and chemotherapy methods. Therefore, both histological and cytological diagnoses are required to enhance diagnostic precision both in our hospital and at other institutions.

Impact of rapid on-site evaluation on diagnostic accuracy of EUS-guided fine-needle aspiration of solid pancreatic lesions: experience from a single center

“…The reason for this may be the intervention of the cytopathologist/ pathologist/ cytology technician who qualifies the cytological material as insufficient during ROSE, increasing the number of passes and the manipulation for obtaining tissue, also spreading the tissue to the slides and forming the appropriate cell block. The advantages of obtaining a cell block, especially with fine needle aspiration, are: being able to see the lesion pattern, performing immunohistochemical staining to support the diagnosis, and acquirement of tissue for molecular analysis, even contributing to the appropriate chemotherapy regimen and molecular targeted therapy [ 19 ].…”

“…Furthermore, Chung et al in their multicenter study, suggested 4 as the optimum number of passes to be applied in centers that do not use ROSE in Korea [ 5 ]. Mizutani et al demonstrated the contribution of the cell block acquirement to make the definitive diagnosis, in terms of the applicability of ancillary tests and molecular studies [ 19 ]. Therefore, even a single cell block from the lesion can be very valuable, increasing the sensitivity and specificity for accurate diagnosis.…”

On-site evaluation of pancreatic lessions according to Papanicolaou Society of Pancreatobiliary Cytology, how can it contribute to diagnostic accuracy?

“…The reason for this may be the intervention of the cytopathologist/ pathologist/ cytology technician who quali es the cytological material that is insu cient during ROSE, increasing the number of passes and the manipulation for obtaining tissue, also spreading the tissue to the slides and forming the appropriate cell block. The advantages of obtaining a cell block, especially with ne needle aspiration, are being able to see the lesion pattern, performing immunohistochemical staining to support the diagnosis, and acquirement of tissue for molecular analysis, even contributing to the chemotherapy regimen and molecular target therapy [19].…”

“…Furthermore, Chung et al in their multicenter study, they suggested 4 as the optimum number of passes to be applied in centers that do not use ROSE in Korea [5]. Mizutani et al demonstrated the contribution of the cell block acquirement in their study to make the de nitive diagnosis, in terms of the applicability of ancillary tests and molecular studies [19]. Therefore, even a single cell block from the lesion can be very valuable, increasing the sensitivity and speci city for accurate diagnosis.…”

Cytological Evaluation

“…In some hospital facilities, cytological examinations and tissue biopsies are performed together. As the author noted [21], both tests have their own advantages and disadvantages. Unlike tissue biopsy, cytology allows specimens to be obtained from background findings.…”