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. 2020 Feb;8(2):E155-E162.
doi: 10.1055/a-1038-4103. Epub 2020 Jan 22.

Diagnostic yield and agreement on fine-needle specimens from solid pancreatic lesions : comparing the smear technique to liquid-based cytology

Priscilla A van Riet  1 , Rutger Quispel  2 , Djuna L Cahen  1 , Mieke C Snijders-Kruisbergen  3 , Petri van Loenen  3 , Nicole S Erler  4 , Jan-Werner Poley  1 , Lydi M J W van Driel  2 , Sanna A Mulder  2 , Bart J Veldt  2 , Ivonne Leeuwenburgh  5 , Marie-Paule G F Anten  5 , Pieter Honkoop  6 , Annemieke Y Thijssen  6 , Lieke Hol  1 , Mohammed Hadithi  7 , Claire E Fitzpatrick  8 , Ingrid Schot  8 , Jilling F Bergmann  9 , Abha Bhalla  9 , Marco J Bruno  1 , Katharina Biermann  3
Affiliations

Diagnostic yield and agreement on fine-needle specimens from solid pancreatic lesions : comparing the smear technique to liquid-based cytology

Priscilla A van Riet et al. Endosc Int Open. 2020 Feb.

Abstract

Background and study aims The traditional "smear technique" for processing and assessing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is sensitive to artifacts. Processing and evaluation of specimens collected in a liquid medium, liquid-based cytology (LBC) may be a solution. We compared the diagnostic value of EUS-FNA smears to LBC in pancreatic solid lesions in the absence of rapid on-site evaluation (ROSE). Patients and methods Consecutive patients who required EUS-FNA of a solid pancreatic lesion were included in seven hospitals in the Netherlands and followed for at least 12 months. Specimens from the first pass were split into two smears and a vial for LBC (using ThinPrep and/or Cell block). Smear and LBC were compared in terms of diagnostic accuracy for malignancy, sample quality, and diagnostic agreement between three cytopathologists. Results Diagnostic accuracy for malignancy was higher for LBC (82 % (58/71)) than for smear (66 % (47/71), P = 0.04), but did not differ when smears were compared to ThinPrep (71 % (30/42), P = 0.56) or Cell block (62 % (39/63), P = 0.61) individually. Artifacts were less often present in ThinPrep (57 % (24/42), P = 0.02) or Cell block samples (40 % (25/63), P < 0.001) than smears (76 % (54/71)). Agreement on malignancy was equally good for smears and LBC (ĸ = 0.71 versus ĸ = 0.70, P = 0.98), but lower for ThinPrep (ĸ = 0.26, P = 0.01) than smears. Conclusion After a single pass, LBC provides higher diagnostic accuracy than the conventional smear technique for EUS-FNA of solid pancreatic lesions in the absence of ROSE. Therefore, LBC, may be an alternative to the conventional smear technique, especially in centers lacking ROSE.

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Conflict of interest statement

Competing interests None

Figures

Fig. 1
Fig. 1
Agreement on diagnostic accuracy of malignancy and the Bethesda classification for smear, ThinPrep and Cell block.
Fig. 2
Fig. 2
Agreement on sample cellularity and presence of artifacts for smear, ThinPrep and Cell block.
See this image and copyright information in PMC

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