Diagnostic efficacy of liquid-based cytology for solid pancreatic lesion samples obtained with endoscopic ultrasound-guided fine-needle aspiration: Propensity score-matched analysis
Diagnostic efficacy of liquid-based cytology for solid pancreatic lesion samples obtained with endoscopic ultrasound-guided fine-needle aspiration: Propensity score-matched analysis
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DOI：
10.1111/den.12827
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发表时间：
2017-07-01
影响因子：
5.3
通讯作者：
Ido, Akio
中科院分区：
文献类型：
--
作者：
Hashimoto, Shinichi;Taguchi, Hiroki;Ido, Akio
背景与目的关于液体细胞学（LBC）对内镜超声引导下细针穿刺（EUS-FNA）胰腺样本诊断效果的数据缺乏。使用倾向评分匹配，我们回顾性分析了LBC与传统帕氏涂片（CPS）相比对EUS-FNA获得的实体胰腺病变样本的附加诊断价值。方法本队列研究纳入了2009年1月至2014年8月间接受EUS-FNA治疗实体性胰腺病变的126例匹配患者。截至2012年5月（63例患者），将CPS用于EUS-FNA样本的细胞学检查。随后，用LBC进行细胞学分析（63例）。比较了CPS和LBC对恶性肿瘤的诊断率。探讨LBC细胞学误诊的危险因素。结果配对后总恶性率为86%。LBC的诊断敏感性和准确性均高于CPS （96.6% vs 84.0%, P = 0.03; 96.8% vs 87.3%, P = 0.05）。LBC对胰腺头部病变的诊断更敏感（96.4% vs 78.1%, P = 0.04）。胰腺导管腺癌（PDAC）合并LBC的敏感性较高（98.1% vs 83.0%, P = 0.009）。多因素分析显示PDAC以外的恶性肿瘤（P = 0.004）和病变大小20 mm （P = 0.046）是所有参与者LBC误诊的危险因素。结论对于实体性胰腺病变，EUS-FNA样本的LBC有助于恶性肿瘤的诊断。除PDAC和小肿瘤外的恶性肿瘤，EUS-FNA和LBC难以诊断。
Background and AimThere is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic samples obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Using propensity score matching, we retrospectively analyzed the additional diagnostic value of LBC compared to a conventional Papanicolaou smear (CPS) for samples of solid pancreatic lesions obtained by EUS-FNA.MethodsThis cohort study included 126 matched patients who underwent initial EUS-FNA for solid pancreatic lesions between January 2009 and August 2014. CPS was used for cytology of EUS-FNA samples obtained until May 2012 (63 patients). Subsequently, LBC was used for cytological analysis (63 patients). Diagnostic yields of CPS and LBC for malignancy were compared. Risk factors for cytological misdiagnosis with LBC were investigated.ResultsOverall rate of malignancy was 86% after matching. LBC had higher diagnostic sensitivity and accuracy than CPS (96.6% vs 84.0%, P = 0.03; and 96.8% vs 87.3%, P = 0.05). LBC was significantly more sensitive for diagnosing pancreatic head lesions (96.4% vs 78.1%, P = 0.04). The sensitivity for pancreatic ductal adenocarcinoma (PDAC) with LBC was higher (98.1% vs 83.0%, P = 0.009). Multivariate analysis revealed that malignant tumors other than PDAC (P = 0.004) and lesion size 20 mm (P = 0.046) were risk factors for LBC misdiagnosis in all participants.ConclusionsFor solid pancreatic lesions, LBC of EUS-FNA samples contributes to the diagnosis of malignancy. Malignant tumors other than PDAC and small tumors are difficult to diagnose using EUS-FNA and LBC.