Digestive Diseases and Sciences

, Volume 55, Issue 10, pp 2756–2766

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

Review

DOI: 10.1007/s10620-010-1361-8

Cite this article as:
Thosani, N., Thosani, S., Qiao, W. et al. Dig Dis Sci (2010) 55: 2756. doi:10.1007/s10620-010-1361-8

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.

Conclusions

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.

Keywords

EUSFNACytologyMeta-analysisPancreatic cyst lesions

Abbreviations

EUS

Endoscopic ultrasound

FNA

Fine-needle aspiration

PCL

Pancreatic cyst lesions

PCN

Pancreatic cyst neoplasm

NMCLs

Non-mucinous cystic lesions

MCL

Mucinous cystic lesions

PC

Pseudocyst

SCA

Serous cyst adenoma

SPT

Solid pseudopapillary tumor

PET

Pancreatic endocrine tumor

IPMN

Intraductal papillary mucinous neoplasms

CEA

Carcinoembryonic antigen

LR

Likelihood ratio

SROC

Summary receiver operating characteristic

DOR

Diagnostic odds ratio

AUC

Area under curve

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Internal MedicineThe University of Texas Health Sciences Center at HoustonHoustonUSA
  2. 2.Departments of BiostatisticsThe University of Texas MD Anderson Cancer Center HoustonHoustonUSA
  3. 3.Surgical OncologyThe University of Texas MD Anderson Cancer Center HoustonHoustonUSA
  4. 4.Department of Gastroenterology, Hepatology, and Nutrition, Unit 1466The University of Texas MD Anderson Cancer Center HoustonHoustonUSA