Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: A systematic review and meta-analysis |
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| Institution: | 1. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;2. Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan;3. Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, United States;4. Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, TX, United States;1. Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota;2. Division of Cytopathology, University of Minnesota, Minneapolis, Minnesota;3. Washington University, St. Louis, Missouri;4. Division of Gastroenterology, VA Medical Center, Minneapolis, Minnesota;5. Patient Centered Research, Aurora Health Care, Milwaukee, Wisconsin, USA;6. Department of Pathology, Aurora Health Care, Milwaukee, Wisconsin, USA;7. Department of Gastroenterology, Aurora Health Care, Milwaukee, Wisconsin, USA;1. Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan;10. Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan;3. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan;4. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan;6. Department of Gastroenterology, Hakodate Municipal Hospital, Hakodate, Japan;5. Department of Gastroenterology, Japan Red Cross Date General Hospital, Date, Japan;7. Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan;12. Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan;8. Department of Gastroenterology, Steel Memorial Muroran Hospital, Muroran, Japan;1. First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan;2. Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, Japan;3. Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan |
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| Abstract: | ObjectivesDifferential diagnosis of malignant and benign intraductal papillary mucinous neoplasms (IPMNs) is essential to determine the optimal treatment. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently used to diagnose pancreatic cystic lesions worldwide, but few studies have focused on the diagnostic yield to distinguish malignant and benign IPMNs. Therefore, we aim to systematically review the diagnostic yield of EUS-FNA-based cytology to distinguish malignant and benign IPMNs.MethodsRelevant studies with a reference standard of definitive surgical histology which published between 2002 and 2012 were identified via MEDLINE and SCOPUS. Malignant IPMNs included invasive adenocarcinoma, carcinoma in situ, and high-grade dysplasia.ResultsFour studies with 96 patients were included in this meta-analysis. For diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs, the pooled sensitivity and specificity were 64.8% (95% CI, 0.44–0.82) and 90.6% (95% CI, 0.81–0.96), respectively. Similarly, the positive likelihood ratio and negative likelihood ratio were 6.35 (95% CI, 2.95–13.68) and 0.43 (95% CI, 0.14–1.34), respectively. Malignant IPMNs were observed in 20.8% (20/96) of patients in EUS-FNA studies.ConclusionsEUS-FNA-based cytology has good specificity but poor sensitivity in differentiating benign from malignant IPMNs. Newer techniques or markers are needed to improve diagnostic yield. |
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| Keywords: | Intraductal papillary mucinous neoplasm Endoscopic ultrasound-guided fine-needle aspiration Cytology Malignancy Meta-analysis Pancreatic cystic lesion |
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