Role of EUS-FNA-Based Cytology in the Diagnosis of Mucinous Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Abstract

Background Preoperative diagnosis of malignancy in pancreatic cystic lesions (PCLs) remains challenging. Most non-mucinous cystic lesions (NMCLs) are benign, but mucinous cystic lesions (MCLs) are more likely to be premalignant or malignant. Aim The aim of this study was to assess the sensitivity, specificity, and positive and negative likelihood ratios (LRs) of EUS-FNA based cytology in differentiating MCLs from non-mucinous PCLs. Methods We conducted a comprehensive search of MEDLINE, SCOPUS, Cochrane, and “CINAHL Plus” databases to identify studies, in which the results of EUS-FNA based cytology of PCLs were compared with those of surgical biopsy or surgical excision histopathology. A DerSimonian-Laird random effect model was used to estimate the pooled sensitivity, specificity, and LRs, and a summary receiver-operating characteristic (SROC) curve was constructed. Results We included 376 patients from 11 distinct studies who underwent EUS-FNA based cytology and also had histopathological diagnosis. The pooled sensitivity and specificity in diagnosing MCLs were 0.63 (95% CI, 0.56–0.70) and 0.88 (95% CI, 0.83–0.93), respectively. The positive and negative LRs in diagnosing MCLs were 4.46 (95% CI, 1.21–16.43) and 0.46 (95% CI, 0.25–0.86), respectively. The area under the curve (AUC) was 0.89. Conclusion EUS-FNA based cytology has overall low sensitivity but good specificity in differentiating MCLs from NMCLs. Further research is required to improve the overall sensitivity of EUS-FNA based cytology to diagnose MCLs while evaluating PCL.

Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle

“…A meta-analysis [73] comparing EUS-FNA-based cytology with surgical biopsy or histology and including 376 patients from eleven [42,58,59,61,[74][75][76][77][78][79][80] studies showed a low sensitivity (63%), but good specificity (88%) in differentiating mucinous cystic lesions from non-mucinous lesions, with a diagnostic accuracy of 89%. However, the authors concluded that review literature on diagnostic accuracy of EUS-FNA-based cytology for pancreatic cystic lesions is limited and heterogeneous, and that welldesigned randomized trials are needed in this field.…”

Pancreatic Cystic Neoplasms: Diagnosis, Management and Indications for Surgical Procedures. Part II

“…Therefore, a MCN will always be suspected when a medial-distal (corporeo-caudal) cystic lesion is identified in a middle-aged woman, the "mother" tumour, with no history of pancreatitis. Unlike SCN (serous cystic neoplasm), MCN are often malignant or they have a malignant potential (3).…”

Recent developments in endoscopic ultrasound-guided diagnosis and therapy of pancreatic cystic neoplasms

“…Despite best efforts, the sensitivity of cytology from EUS-FNA aspirates is in the range of 63% and specificity of 88% according to a meta-analysis by Thosani et al 21 There is a need for development and adoption of reliable surrogate cytological and molecular markers that can identify the type of pancreatic cyst and the degree of dysplasia.…”