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

Abstract

Background: The use of ROSE in EUS-FNA pancreatic lesions is still controversial in many centers. In this study, we aimed to demonstrate the diagnostic accuracy of ROSE and its contribution to the diagnostic accuracy, as well as its assistance to the pathologist/cytopathologist.Methods: 162 EUS-FNA biopsies were included in the study. EUS-FNA cytology results were reported according to the six-tiered system of Papanicolaou Cytopathology Society and compared to their final diagnosis with histopathology and/or clinical follow-ups regarding malignancy. In ROSE and non-ROSE patients, diagnostic ability , the difference in diagnostic accuracy, and its contribution to providing the pathologist with sufficient amount of tissue acquisition (number of slides and cell blocks) for later examination were compared.Results: In the non-ROSE group, the diagnostic accuracy according to the final diagnoses was 96% and the sensitivity was 94.44%, specificity 100%, PPV 100%, NPV 87.50%; while diagnostic accuracy was 97.09%, sensitivity 97.47%, specificity 95.83%, PPV 98.77%, NPV 92% in patients with ROSE. There was no significant difference in diagnostic accuracy between those with and without ROSE (p:0.078). In diagnostic cases, the number of passes, slides and cell blocks were significantly higher in patients with ROSE than those without ROSE (p:0.003, p:0.007, p:0.012, respectively). ROSE was independently associated with diagnostic ability when evaluated by number of passes, slides, cell blocks in regression analysis (p:0.001, OR:5.07, confidence interval: 1.89-13.5). If the lesion is solid or contains a solid component, cytological corcordance with final diagnosis is higher than cystic ones (p<0.001).Conclusion: ROSE may increase the acquisition of sufficient tissue, but it does not have an advantage in diagnostic accuracy. ROSE may raise the number of required slides, which may benefit the pathologist in making the diagnosis. If the lesion is solid and/or contains a solid component, the success of obtaining a diagnostic ability is higher in patients with ROSE than in those without. Therefore, ROSE still maintains its applicability in terms of making the final diagnosis to the patient and increasing the diagnostic efficiency.