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Comparative Study
. 2024 Jun 2;60(6):930.
doi: 10.3390/medicina60060930.

Diagnostic Assessment of Endoscopic Ultrasonography-Fine Needle Aspiration Cytology in the Pancreas: A Comparison between Liquid-Based Preparation and Conventional Smear

Jung-Soo Pyo  1 , Dae Hyun Lim  2 , Kyueng-Whan Min  1 , Nae Yu Kim  2 , Il Hwan Oh  2 , Byoung Kwan Son  2
Affiliations
Comparative Study

Diagnostic Assessment of Endoscopic Ultrasonography-Fine Needle Aspiration Cytology in the Pancreas: A Comparison between Liquid-Based Preparation and Conventional Smear

Jung-Soo Pyo et al. Medicina (Kaunas). .

Abstract

Background and Objectives: This study aimed to elucidate the cytologic characteristics and diagnostic usefulness of endoscopic ultrasonography-fine needle aspiration cytology (EUS-FNAC) by comparing it with liquid-based preparation (LBP) and conventional smear (CS) in pancreas. Methods: The diagnostic categories (I through VII) were classified according to the World Health Organization Reporting System for Pancreaticobiliary Cytopathology. Ten cytologic features, including nuclear and additional features, were evaluated in 53 cases subjected to EUS-FNAC. Nuclear features comprised irregular nuclear contours, nuclear enlargement, hypochromatic nuclei with parachromatin clearing, and nucleoli. Additional cellular features included isolated atypical cells, mucinous cytoplasm, drunken honeycomb architecture, mitosis, necrotic background, and cellularity. A decision tree analysis was conducted to assess diagnostic efficacy. Results: The diagnostic concordance rate between LBP and CS was 49.1% (26 out of 53 cases). No significant differences in nuclear features were observed between categories III (atypical), VI (suspicious for malignancy), and VII (malignant). The decision tree analysis of LBP indicated that cases with moderate or high cellularity and mitosis could be considered diagnostic for those exhibiting nuclear atypia. Furthermore, in CS, mitosis, isolated atypical cells, and necrotic background exerted a more significant impact on the diagnosis of EUS-FNAC. Conclusions: Significant parameters for interpreting EUS-FNAC may differ between LBP and CS. While nuclear atypia did not influence the diagnosis of categories III, VI, and VII, other cytopathologic features, such as cellularity, mitosis, and necrotic background, may present challenges in diagnosing EUS-FNAC.

Keywords: conventional smear; decision tree analysis; endoscopic ultrasonography; fine needle aspiration cytology; liquid-based preparation; pancreas.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Representative images for endoscopic ultrasonography–fine needle aspiration cytology (EUS-FNAC) with liquid-based preparation (A,C,E) and conventional smear (B,D,F). (A,B) Low magnification (×100). (C–F) High magnification (×400; arrow, atypical mitosis).
Figure 2
Figure 2
Distributions of cytopathologic features of each diagnostic category in endoscopic ultrasonography–fine needle aspiration cytology (EUS-FNAC) with liquid-based preparation and conventional smear. (A) Overall features. (B) Nuclear features. (C) Cellular features. (CS, conventional smear; LBP, liquid-based preparation).
Figure 3
Figure 3
Decision tree for endoscopic ultrasonography–fine needle aspiration cytology (EUS-FNAC) with liquid-based preparation (A) and conventional smear (B).
See this image and copyright information in PMC

References

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