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Notohara K, Nakamura K. Tissue processing of endoscopic ultrasound-guided fine-needle aspiration specimens from solid pancreatic lesions. J Med Ultrason (2001) 2024; 51:261-274. [PMID: 38051462 DOI: 10.1007/s10396-023-01387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023]
Abstract
Now that tissue cores can be obtained using fine-needle biopsy (FNB) needles, the ways tissues are handled for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are changing. Direct smear, touch smear of core tissues, and centrifugation have been used for cytological examinations, and liquid-based cytology (LBC), which allows immunostaining and genetic tests that use residual samples, is emerging as an alternative. We emphasize that liquid cytology (Cytospin™ cytology and LBC) is still important, because it enables the diagnosis of pancreatic ductal adenocarcinoma (PDAC) when cancerous cells are scarce in specimens. Cell blocks are being replaced by core tissues obtained via FNB needles. Recent reports indicate that rapid on-site evaluation (ROSE) is not necessary when FNB needles are used, and macroscopic on-site evaluation is used to evaluate specimen adequacy. Macroscopic findings of specimens are helpful in the diagnostic workup and for clarifying specimen-handling methods. In addition to the red strings and white cores observed in PDAC, mixed red and white strings, gray tissues, and gelatinous tissues are observed. Gray (necrotic) tissues and gelatinous (mucus) tissues are more suitable than histology for cell block or cytological processing. Tumor cells in neuroendocrine tumors (NETs) are numerous in red strings but cannot be observed macroscopically. ROSE might thus be necessary for lesions that may be NETs. Core tissues can be used for genetic tests, such as those used for KRAS mutations and comprehensive genomic profiling. Cytological materials, including slides and LBC specimens, can also be genetic test materials.
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Affiliation(s)
- Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan.
| | - Kaori Nakamura
- Pathological Laboratory, Division of Medical Technology, Kurashiki Central Hospital, Kurashiki, Japan
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Yan X, Zhou G, Ji J, Gui Y, Chang X, Zhang J, Lv K, Tan L. Evaluation of the diagnostic efficacy of liquid-based cytology obtained via percutaneous ultrasound-guided fine-needle aspiration for pancreatic masses: a large tertiary center's 8-year experience. J Cancer Res Clin Oncol 2023; 149:17189-17197. [PMID: 37783929 DOI: 10.1007/s00432-023-05438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE There were limited data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic tissues acquired by percutaneous ultrasound-guided fine-needle aspiration (US-FNA). This study aimed to evaluate the diagnostic value of LBC acquired via percutaneous US-FNA for pancreatic tumors compared with LBC combined with smear cytology (SC). METHODS A retrospective database search (January 2014 and February 2022) was performed for patients who underwent percutaneous US-FNA with both LBC and SC. Clinical and pathological data were collected from 298 patients; eventually, 251 cases met the inclusion criteria. Diagnostic accuracy, sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) were compared. Rapid on-site evaluation (ROSE) was not available in all cases. RESULTS Based on the pancreaticobiliary cytology guidelines published by the Papanicolaou Society of Cytopathology, 224 (89.2%), 13 (5.2%) and 14 (5.6%) cases were diagnosed as malignant, pre-malignant and benign lesions, respectively. The diagnostic accuracy of the LBC + SC (88.5%) was better than that of LBC (87.3%) but without statistical significance (P = 0.125). The SEN, SPE, PPV and NPV were 87.5%, 85.2%, 98.0% and 45.1%, respectively, in the LBC group and 88.8%, 85.2%, 98.0% and 47.9%, respectively, in the LBC + SC group. According to univariate and multivariate analyses, there were no factors have significant association with the diagnostic sensitivity of LBC. CONCLUSIONS LBC obtained via percutaneous US-FNA provides good diagnostic value for pancreatic lesions and there was no significant difference between the diagnostic accuracy of LBC and LBC + SC when ROSE was unavailable.
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Affiliation(s)
- Xiaoyi Yan
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Guili Zhou
- Department of Ultrasound, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, 518000, China
| | - Jiaqi Ji
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yang Gui
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jing Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ke Lv
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Li Tan
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Wang W, Han C, Ling X, Guo X, Liu J, Lin R, Ding Z. Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology. Front Med (Lausanne) 2023; 10:1221085. [PMID: 37720508 PMCID: PMC10501754 DOI: 10.3389/fmed.2023.1221085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established method for the evaluation of abdominal organ lesions. However, there are few studies on EUS-FNA for abdominal lymph node (LN) lesions. The purpose of this study was to evaluate the diagnostic role of EUS-FNA in isolated abdominal lymphadenopathy (LAP). Methods A retrospective analysis was performed on patients with isolated abdominal LAP who underwent a EUS-FNA examination. The diagnosis was made based on cytology, histology, and immunohistochemical (IHC) studies. The area under curve (AUC) value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results A total of 99 patients were included in this study. The final diagnoses were metastatic tumor (n = 32), lymphoma (n = 32), tuberculosis (n = 17), sarcoidosis (n = 5), castleman's disease (n = 1), and reactive LAP (n = 12). The AUC value, sensitivity, specificity, PPV, NPV, and accuracy of EUS-FNA in the diagnosis of malignant LAP were 0.9531, 90.6, 100, 100, 85.4, and 93.9%, respectively. For the diagnosis of lymphoma, the accuracy of EUS-FNA combined with IHC staining was 94.9%. Retroperitoneal LN enlargement is more commonly associated with lymphoma, while hepatic hilar LN enlargement predominantly suggests benign conditions or metastatic tumors. Malignant lymph nodes are more likely to be regular border, circular/quasi-circular, and fusion. Lymphomas are more likely to present with fusion and heterogeneous echogenicity than metastatic tumors. Conclusion EUS-FNA is a safe and effective method to diagnose isolated abdominal LAP.
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Affiliation(s)
- Wenli Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoqun Han
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Ling
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianwen Guo
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Lin
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Ding
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Jun JC, Lee SH, Lee HM, Kim SG, Chung H, Kim JS, Park N, Choi JH, Kwak Y, Cho SJ. A prospective randomized noninferiority trial comparing conventional smears and SurePathTM liquid-based cytology in endoscopic ultrasound-guided sampling of esophageal, gastric, and duodenal lesions. Medicine (Baltimore) 2023; 102:e34321. [PMID: 37478273 PMCID: PMC10662805 DOI: 10.1097/md.0000000000034321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Several liquid-based cytology (LBC) methods are currently used, but the diagnostic accuracy of each method is not well known. We aimed to compare the diagnostic performance of SurePathTM LBC and conventional smear (CS) cytology in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of esophageal, gastric, and duodenal lesions. METHODS As a prospective randomized noninferiority study, patients who needed EUS-FNA due to subepithelial mass in the upper gastrointestinal tract were randomly assigned 1:1 to the LBC and CS groups. Cytologic preparation was carried out using a crossover design where 1 method was used for the first needle-pass sample and another method was used for the second needle-pass sample. The primary outcome was to compare the diagnostic performance between LBC and CS using the final diagnosis as the gold standard. RESULTS A total of 87 patients were randomized and 60 patients were analyzed. There were no differences between LBC and CS in diagnostic accuracy (91.7% vs 86.7%, P = .380), sensitivity (97.7% vs 90.7%, P = .169), specificity (76.5% vs 76.5%, P > .99), negative predictive value (92.9% vs 76.5%, P = .225), or positive predictive value (91.3% vs 90.7%, P = .921). The background of LBC was less bloody than that of CSs (5.0% vs 53.3%, P < .001) and the sample preparation time of LBC was shorter than that of CSs (29 ± 7 seconds vs 90 ± 17 seconds, P < .001). CONCLUSION In the EUS-FNA of a subepithelial mass in the upper gastrointestinal tract, the diagnostic performance of LBC was not inferior to that of CS. The field of view was better in LBC, because the background was less bloody and necrotic. As LBC is more convenient to perform and takes shorter time, it is expected that it can replace the CS method for EUS-FNA samples.
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Affiliation(s)
- Jae Chang Jun
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Myung Lee
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Seong Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Namyoung Park
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Choi
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Next-Generation Sequencing Analysis of Pancreatic Cancer Using Residual Liquid Cytology Specimens from Endoscopic Ultrasound—Guided Fine-Needle Biopsy: A Prospective Comparative Study with Tissue Specimens. Diagnostics (Basel) 2023; 13:diagnostics13061078. [PMID: 36980386 PMCID: PMC10047095 DOI: 10.3390/diagnostics13061078] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
This study evaluated the feasibility and clinical utility of liquid-based cytology (LBC) specimens via endoscopic ultrasound–guided fine-needle biopsy (EUS-FNB) for next-generation sequencing (NGS) of pancreatic cancer (PC). We prospectively evaluated the performance of DNA extraction and NGS using EUS-FNB samples obtained from PC. Thirty-three consecutive patients with PC who underwent EUS-FNB at our hospital were enrolled. DNA samples were obtained from 96.8% of the patients. When stratified with a variant allele frequency (VAF) > 10% tumor burden, the NGS success rate was 76.7% (n = 23) in formalin-fixed paraffin-embedded (FFPE), 83.3% (n = 25) in LBC, and 76.7% (n = 23) in frozen samples. The overall NGS success rate was 86.7% (n = 26) using FFPE, LBC, or frozen samples. The detection rates for the main mutated genes were as follows: 86.7% for KRAS, 73.3% for TP53, 66.7% for CDKN2A, 36.7% for SMAD4, and 16.7% for ARID1A. LBC had the highest median value of VAF (23.5%) for KRAS and TP53. PC mutation analysis using NGS was successfully performed using LBC compared with FFPE and frozen samples. This approach provides an alternative and affordable source of molecular testing materials.
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Kitagawa K, Mitoro A, Tomooka F, Asada S, Fujinaga Y, Nishimura N, Kaji K, Kawaratani H, Akahane T, Ozutsumi T, Kaneko M, Fujimoto Y, Tsuji Y, Enomoto M, Takeda S, Murata K, Kubo T, Iwai S, Koizumi A, Shibamoto A, Suzuki J, Tanaka M, Matsuda T, Yorioka N, Masuda H, Takami M, Yoshiji H. Diagnostic yield of liquid-based cytology in serial pancreatic juice aspiration cytological examination. DEN OPEN 2022; 3:e177. [PMID: 36304177 PMCID: PMC9593257 DOI: 10.1002/deo2.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Objectives Serial pancreatic juice aspiration cytological examination (SPACE) via endoscopic retrograde cholangiopancreatography is a useful diagnostic method for early‐stage pancreatic cancer, such as carcinoma in situ that are difficult to diagnose by endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA). However, the diagnostic accuracy of SPACE is low, which is attributed to problems regarding specimen treatment. Hence, we evaluated the diagnostic efficacy of liquid‐based cytology (LBC) in pancreatic juice cytology for pancreatic cancer. Methods We retrospectively analyzed 24 patients with suspected pancreatic cancer that was difficult to diagnose by endoscopic ultrasound‐guided fine needle aspiration who underwent SPACE using LBC between April 2017 and April 2021. Results The most common reason for performing SPACE was localized stenosis of the main pancreatic duct without a mass. Eleven patients were diagnosed with malignancy after surgical resection, nine of whom had pancreatic ductal adenocarcinoma. Ten patients were diagnosed as benign after a follow‐up of more than 1 year. The nine cases of malignancy were diagnosed before surgical resection by SPACE using LBC, with a sensitivity of 81.8% and specificity of 100%. The overall diagnostic accuracy was 91.7%. A total of 152 LBC examinations were performed via SPACE, with an adequate sample collection rate of 88.9%. No adverse events, including acute pancreatitis, occurred after endoscopic retrograde cholangiopancreatography. Conclusion SPACE with LBC offers good diagnostic efficacy in patients with pancreatic cancer that is difficult to diagnose by endoscopic ultrasound‐guided fine needle aspiration.
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Affiliation(s)
- Koh Kitagawa
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Akira Mitoro
- Division of EndoscopyNara Medical UniversityNaraJapan
| | | | - Shohei Asada
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | | | - Kosuke Kaji
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Takemi Akahane
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Miki Kaneko
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Yuki Fujimoto
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Yuki Tsuji
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Soichi Takeda
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Koji Murata
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Takahiro Kubo
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Satoshi Iwai
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | | | - Junya Suzuki
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Misako Tanaka
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | - Takuya Matsuda
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Hiroyuki Masuda
- Department of GastroenterologyNara Medical UniversityNaraJapan
| | | | - Hitoshi Yoshiji
- Department of GastroenterologyNara Medical UniversityNaraJapan
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Itonaga M, Ashida R, Kitano M. The usefulness of liquid-based cytology for endoscopic ultrasound-guided tissue acquisition of solid pancreatic masses. Front Med (Lausanne) 2022; 9:943792. [PMID: 36052322 PMCID: PMC9424663 DOI: 10.3389/fmed.2022.943792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Liquid-based cytology (LBC) is used primarily for cervical cytology, although it is also used for analyzing liquid samples such as urine and ascites specimens, as well as fine needle aspiration material, such as those obtained from breast and thyroid. The usefulness of the LBC method for endoscopic ultrasound-guided tissue acquisition (EUS-TA) of solid pancreatic masses was recently reported. The LBC method can produce multiple pathological slides and can be applied to immunocytochemistry and genetic analyses. In this article, we review the usefulness of LBC for EUS-TA of solid pancreatic masses.
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Yokoyama S, Iwaya H, Akahane T, Hamada T, Higashi M, Hashimoto S, Tanoue S, Ohtsuka T, Ido A, Tanimoto A. Sequential evaluation of
MUC
promoter methylation using next‐generation sequencing‐based custom‐made panels in liquid‐based cytology specimens of pancreatic cancer. Diagn Cytopathol 2022; 50:499-507. [DOI: 10.1002/dc.25022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Sieya Yokoyama
- Department of Pathology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Hiromichi Iwaya
- Digestive and Lifestyle Diseases Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Toshiaki Akahane
- Department of Pathology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
- Center for Human Genome and Gene Analysis Kagoshima University Hospital Kagoshima Japan
| | - Taiji Hamada
- Department of Pathology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Michiyo Higashi
- Unit of Surgical Pathology Kagoshima University Hospital Kagoshima Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Shiroh Tanoue
- Digestive and Lifestyle Diseases Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Akihide Tanimoto
- Department of Pathology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
- Center for Human Genome and Gene Analysis Kagoshima University Hospital Kagoshima Japan
- Unit of Surgical Pathology Kagoshima University Hospital Kagoshima Japan
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9
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The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions. Diagnostics (Basel) 2022; 12:diagnostics12030753. [PMID: 35328306 PMCID: PMC8947755 DOI: 10.3390/diagnostics12030753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 02/07/2023] Open
Abstract
Endoscopic-ultrasonography-guided tissue acquisition (EUS-TA) has been widely performed for the definitive diagnosis of solid pancreatic lesions (SPLs). As the puncture needles, puncture techniques, and sample processing methods have improved, EUS-TA has shown higher diagnostic yields and safety. Recently, several therapeutic target genomic biomarkers have been clarified in pancreatic ductal carcinoma (PDAC). Although only a small proportion of patients with PDAC can benefit from precision medicine based on gene mutations at present, precision medicine will also be further developed for SPLs as more therapeutic target genomic biomarkers are identified. Advances in next-generation sequencing (NGS) techniques enable the examination of multiple genetic mutations in limited tissue samples. EUS-TA is also useful for NGS and will play a more important role in determining treatment strategies. In this review, we describe the utility of EUS-TA for SPLs.
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Sekita‐Hatakeyama Y, Fujii T, Nishikawa T, Mitoro A, Sawai M, Itami H, Morita K, Uchiyama T, Takeda M, Sho M, Yoshiji H, Hatakeyama K, Ohbayashi C. Evaluation and diagnostic value of next-generation sequencing analysis of residual liquid-based cytology specimens of pancreatic masses. Cancer Cytopathol 2022; 130:202-214. [PMID: 34665935 PMCID: PMC9297882 DOI: 10.1002/cncy.22525] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liquid-based cytology (LBC) is a widely used method for processing specimens obtained by endoscopic biopsy. This study evaluated next-generation sequencing (NGS) analysis of LBC specimens to improve the diagnostic accuracy of pancreatic lesions. METHODS Upon the diagnosis of a suspected pancreatic mass, LBC residues were used retrospectively. The quantity and quality of DNA extracted from residual LBC samples were evaluated, and an NGS analysis targeting 6 genes (KRAS, GNAS, TP53, CDKN2A, SMAD4, and PIK3CA) was performed. RESULTS The library was prepared from LBC specimens taken from 52 cases: 44 were successful, and 8 preparations failed. An analysis of DNA quantity and quality suggested that the success or failure of NGS implementation depended on both properties. The final diagnosis was achieved by a combination of the pathological analysis of the surgical excision or biopsy material with clinical information. Among the 33 cases of pancreatic ductal adenocarcinoma (PDAC), KRAS, TP53, CDKN2A, and SMAD4 mutations were identified in 31 (94%), 16 (48%), 3 (9%), and 2 (6%), respectively. Among the 11 benign cases, only a KRAS mutation was identified in 1 case. On the basis of NGS results, 18 of 33 PDACs (55%) were classified as highly dysplastic or more, and 10 of 11 benign lesions were evaluated as nonmalignant, which was consistent with the final diagnosis. CONCLUSIONS NGS analysis using LBC specimens from which DNA of appropriate quantity and quality has been extracted could contribute to improving the assessment of pancreatic tumor malignancies and the application of molecular-targeted drugs.
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Affiliation(s)
| | - Tomomi Fujii
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Takeshi Nishikawa
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Akira Mitoro
- Department of GastroenterologyNara Medical UniversityKashiharaJapan
| | - Masayoshi Sawai
- Department of GastroenterologyMinami‐Nara General Medical CenterOyodo‐ChoJapan
| | - Hiroe Itami
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Kouhei Morita
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Tomoko Uchiyama
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Maiko Takeda
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
| | - Masayuki Sho
- Department of SurgeryNara Medical UniversityKashiharaJapan
| | - Hitoshi Yoshiji
- Department of GastroenterologyNara Medical UniversityKashiharaJapan
| | - Kinta Hatakeyama
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
- Department of PathologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Chiho Ohbayashi
- Department of Diagnostic PathologyNara Medical UniversityKashiharaJapan
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11
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Kanayama K, Izuhara J. Impact of LBC fixative type and fixation time on molecular analysis of pancreatic cancer cells: A comparative study of cell morphology, antigenicity and nucleic acids. J Cytol 2022; 39:66-71. [PMID: 35814881 PMCID: PMC9261998 DOI: 10.4103/joc.joc_13_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/20/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction: Liquid-based cytology (LBC) has been widely used since 2000. Next-Generation Sequencing (NGS) analysis of residual specimens in LBC fixative may also be performed for pancreatic cancer in the near future. We examined cell morphology, antigenicity and nucleic acids in pancreatic cancer cells at different fixation times using two types of LBC fixatives. Methods: PANC-1 cells were fixed in 1 ml CytoRich Red (CR), CytoRich Blue (CB), 95% ethanol (95% AL) or 10% neutral buffered formalin (10% NBF) and evaluated for cell area, antigenicity and nucleic acids with fixation times of 1 hour and 1, 3, 9, and 14 days. Antigenicity was evaluated by immunocytochemical staining for p53 and CK20, and nucleic acid fragmentation was assessed by real-time PCR. Results: There was no difference in total cell area between 1 hour and 14 day fixation times for the CR group, but the CB group showed cell contraction with 9 days fixation. In immunocytochemical staining, the CR group showed high p53 and CK20 positivity even after 14 days fixation. The CB group had a lower p53 positive rate than the CR group from 1 hour fixation. For nucleic acid fragmentation, Ct values for the CR group increased with fixation time. The CB group had consistently low Ct values. Conclusion: Different LBC fixatives and fixation time can have varying effects on cell morphology, antigenicity and nucleic acids in pancreatic cancer cells. Therefore, fixative type and fixation time should be considered for molecular testing on residual samples in LBC fixatives.
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12
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Zhang XH, Ma SY, Liu N, Wei ZC, Gao X, Hao YJ, Liu YX, Cai YQ, Wang JH. Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis. World J Clin Cases 2021; 9:3308-3319. [PMID: 34002139 PMCID: PMC8107895 DOI: 10.12998/wjcc.v9.i14.3308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/30/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is a safe and accurate technique to confirm the diagnosis of pancreatic cancers. Recently, numerous studies comparing the diagnostic efficacy of smear cytology (SC) and liquid-based cytology (LBC) for pancreatic lesions yielded mixed results.
AIM To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.
METHODS A comprehensive search of PubMed, Embase, and Cochrane was undertaken through July 18, 2020. The primary endpoint was diagnostic accuracy (sensitivity and specificity). Secondary outcomes included sample adequacy and post procedure complications. In addition, factors affecting diagnostic efficacy were discussed.
RESULTS Data on a total of 1121 comparisons from 10 studies met the inclusion criteria. Pooled rates of sensitivity for SC and LBC were 78% (67%-87%) vs 75% (67%-81%), respectively. In any case, both SC and LBC exhibited a high specificity close to 100%. Inadequate samples more often appeared in LBC compared with SC. However, the LBC samples exhibited a better visual field than SC. Very few post procedure complications were observed.
CONCLUSION Our data suggested that for EUS-FNA in pancreatic lesions (particularly solid lesions), SC with Rapid On-Site Evaluation represents a superior diagnostic technique. If Rapid On-Site Evaluation is unavailable, LBC may replace smears. The diagnostic accuracy of LBC depends on different LBC techniques.
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Affiliation(s)
- Xiao-Hui Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Shi-Yang Ma
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Zhong-Cao Wei
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Xu Gao
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Yu-Jie Hao
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Yi-Xin Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Ya-Qin Cai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Jin-Hai Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
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13
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Chandan S, Mohan BP, Khan SR, Ofosu A, Dhaliwal AS, Shah AR, Bhogal N, Mashiana HS, Mashiana SS, Kassab LL, Ponnada S, Facciorusso A, Bhat I, Singh S, Witt BL, Adler DG. Comparison of EUS-guided conventional smear and liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis. Endosc Int Open 2020; 8:E1611-E1622. [PMID: 33140017 PMCID: PMC7581473 DOI: 10.1055/a-1240-0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) has limitations of inadequate sampling and false-negative results for malignancy. It has been performed using conventional smear (CS) cytology with rapid on-site evaluation (ROSE) with reasonable diagnostic accuracy. An alternative to ROSE is liquid-based cytology (LBC). Commonly used LBC techniques include precipitation-based (SurePath™) and filtration-based (ThinPrep ® , CellPrep ® ). Data regarding the diagnostic efficacy of LBC compared with CS are limited. Methods Multiple databases were searched through March 2020 to identify studies reporting diagnostic yield of EUS-guided CS and LBC in pancreatic lesions. Pooled diagnostic odds and rates of performance for the cytologic diagnoses of benign, suspicious, and malignant lesions were calculated. Diagnostic efficacy was evaluated by pooled rates of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results Nine studies with a total of 1308 patients were included in our final analysis. Pooled diagnostic odds of CS cytology were 1.69 (CI 1.02-2.79) and 0.39 (CI 0.19-0.8) for malignant lesions when compared to filtration-based and precipitation-based LBC techniques, respectively. For CS, precipitation-based and filtration-based LBC, pooled diagnostic accuracy was 79.7 %, 85.2 %, 77.3 %, sensitivity was 79.2 %, 83.6 %, 68.3 %, and specificity was 99.4 %, 99.5 %, 99.5 %, respectively. Conclusions The precipitation-based LBC technique (SurePath™) had superior diagnostic odds for malignant pancreatic lesions compared with CS cytology in the absence of ROSE. It showed superior accuracy and sensitivity, but comparable specificity and PPV. Diagnostic odds of CS cytology in the absence of ROSE were superior to the filtration-based LBC technique (ThinPrep ® , Cellprep ® ) for diagnosing malignant pancreatic lesions.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew Ofosu
- Division of Gastroenterology & Hepatology, Stanford University, Stanford, California, United States
| | - Amaninder S. Dhaliwal
- Division of Digestive Diseases & Nutrition, University of South Florida, Tampa, Florida, USA
| | - Aun R. Shah
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Neil Bhogal
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Harmeet S. Mashiana
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Simran S. Mashiana
- Pathology & Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Ishfaq Bhat
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailender Singh
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Benjamin L. Witt
- Cytopathology Section, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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14
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van Riet PA, Quispel R, Cahen DL, Erler NS, Snijders-Kruisbergen MC, Van Loenen P, Poley JW, van Driel LMJW, Mulder SA, Veldt BJ, Leeuwenburgh I, Anten MPGF, Honkoop P, Thijssen AY, Hol L, Hadithi M, Fitzpatrick CE, Schot I, Bergmann JF, Bhalla A, Bruno MJ, Biermann K. Optimizing cytological specimens of EUS-FNA of solid pancreatic lesions: A pilot study to the effect of a smear preparation training for endoscopy personnel on sample quality and accuracy. Diagn Cytopathol 2020; 49:295-302. [PMID: 33098625 PMCID: PMC7820998 DOI: 10.1002/dc.24645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND In the absence of rapid on-side pathological evaluation, endoscopy staff generally "smears" endoscopic ultrasound guided fine needle aspiration (EUS-FNA) specimens on a glass slide. As this technique is vulnerable to preparation artifacts, we assessed if its quality could be improved through a smear-preparation-training for endoscopy staff. METHODS In this prospective pilot study, 10 endosonographers and 12 endoscopy nurses from seven regional EUS-centers in the Netherlands were invited to participate in a EUS-FNA smear-preparation-training. Subsequently, post training slides derived from solid pancreatic lesions were compared to pre-training "control" slides. Primary outcome was to assess if the training positively affects smear quality and, consequently, diagnostic accuracy of EUS-FNA of solid pancreatic lesions. RESULTS Participants collected and prepared 71 cases, mostly pancreatic head lesions (48%). Sixty-eight controls were selected from the pretraining period. The presence of artifacts was comparable for smears performed before and after training (76% vs 82%, P = .36). Likewise, smear cellularity (≥50% target cells) before and after training did not differ (44% (30/68) vs 49% (35/71), P = .48). Similar, no difference in diagnostic accuracy for malignancy was detected (P = .10). CONCLUSION In this pilot EUS-FNA smear-preparation-training for endoscopy personnel, smear quality and diagnostic accuracy were not improved after the training. Based on these results, we plan to further study other training programs and possibilities.
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Affiliation(s)
- Priscilla A van Riet
- Department of Gastroenterology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rutger Quispel
- Deparment of Hepatology and Gastroenterology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Djuna L Cahen
- Department of Gastroenterology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Petri Van Loenen
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lydi M J W van Driel
- Deparment of Hepatology and Gastroenterology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Sanna A Mulder
- Deparment of Hepatology and Gastroenterology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Bart J Veldt
- Deparment of Hepatology and Gastroenterology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Ivonne Leeuwenburgh
- Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands
| | - Marie-Paule G F Anten
- Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands
| | - Pieter Honkoop
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annemieke Y Thijssen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Lieke Hol
- Department of Gastroenterology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mohammed Hadithi
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Claire E Fitzpatrick
- Department of Gastroenterology and Hepatology, IJsselland Hospital, Rotterdam, The Netherlands
| | - Ingrid Schot
- Department of Gastroenterology and Hepatology, IJsselland Hospital, Rotterdam, The Netherlands
| | - Jilling F Bergmann
- Department of Gastroenterology and Hepatology, HAGA, The Hague, The Netherlands
| | - Abha Bhalla
- Department of Gastroenterology and Hepatology, HAGA, The Hague, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands and Institute for Pathology, Dueren, Germany
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15
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Pan HH, Zhou XX, Zhao F, Chen HY, Zhang Y. Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis. World J Clin Cases 2020; 8:3006-3020. [PMID: 32775382 PMCID: PMC7385618 DOI: 10.12998/wjcc.v8.i14.3006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/25/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smear cytology (SC) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the established and traditional choice for diagnosing pancreatic lesions. Liquid-based cytology (LBC) is a novel alternative cytological method, however, the comparative diagnostic efficacy of LBC remains inconclusive.
AIM To examine the diagnostic efficacy of LBC and SC for pancreatic specimens obtained through EUS-FNA via a systematic review and meta-analysis.
METHODS A systematic literature search was performed using PubMed, EMBASE, the Cochrane Library, and Web of Science. The numbers of true positives, false positives, true negatives, and false negatives for each cytological test (LBC and CS) were extracted from the included studies. The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve (AUC) were calculated, and the AUC was compared by Tukey's multiple comparisons test. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies II tool.
RESULTS A total of 1656 patients in eight studies were included. The pooled sensitivity and specificity and the AUC for LBC were 0.76 (95%CI: 0.72-0.79), 1.00 (95%CI: 0.98-1.00), and 0.9174, respectively, for diagnosing pancreatic lesions. The pooled estimates for SC were as follows: Sensitivity, 0.68 (95%CI: 0.64-0.71); specificity, 0.99 (95%CI: 0.96-100.00); and AUC, 0.9714. Similarly, the corresponding values for LBC combined with SC were 0.87 (95%CI: 0.84-0.90), 0.99 (95%CI: 0.96-1.00), and 0.9894. Tukey’s multiple comparisons test was used to compare the sensitivities and AUCs of the three diagnostic methods; statistically significant differences were found between the three methods, and LBC combined with SC was superior to both LBC (P < 0.05) and SC (P < 0.05). The pooled sensitivity and AUC did not change significantly in the sensitivity analysis.
CONCLUSION LBC may be sensitive than SC in the cytological diagnosis of pancreatic lesions, however, the superior diagnostic performance of their combination emphasizes their integrated usage in the clinical evaluation of pancreatic lesions.
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Affiliation(s)
- Hang-Hai Pan
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xin-Xin Zhou
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Fei Zhao
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Hui-Yan Chen
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yu Zhang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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16
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Ko SH, Pyo JS, Son BK, Lee HY, Oh IW, Chung KH. Comparison between Conventional Smear and Liquid-Based Preparation in Endoscopic Ultrasonography-Fine Needle Aspiration Cytology of Pancreatic Lesions. Diagnostics (Basel) 2020; 10:diagnostics10050293. [PMID: 32397572 PMCID: PMC7277982 DOI: 10.3390/diagnostics10050293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to compare the diagnostic accuracy between conventional smear (CS) and liquid-based preparation (LBP) in endoscopic ultrasonography-fine needle aspiration cytology (EUS-FNAC) of pancreatic lesions. Using 31 eligible studies, the diagnostic accuracy of cytologic examination in CS and LBP was evaluated through a conventional meta-analysis and diagnostic test accuracy review. Overall concordance rates were 82.8% (95% confidence interval [CI], 79.8–85.5%) and 94.0% (95% CI, 84.4–97.8%) in CS and LBP, respectively. CS with rapid on-site evaluation (ROSE) showed a higher concordance rate than CS without ROSE. In CS, the pooled sensitivity and specificity were 89.8% (95% CI, 85.2–93.1%) and 95.0% (95% CI, 90.0–97.6%), respectively. The diagnostic odds ratio (OR) and area under curve (AUC) of the summary receiver operating characteristic (SROC) curve were 90.32 (95% CI, 43.85–147.11) and 0.945, respectively. In LBP, the pooled sensitivity and specificity were 80.9% (95% CI, 69.7–88.7%) and 99.9% (95% CI, 1.5–100.0%), respectively. The diagnostic OR and AUC of the SROC curve were 57.21 (95% CI, 23.61–138.64) and 0.939, respectively. Higher concordance rates were found in CS with ROSE and LBP in EUS-FNAC of pancreatic lesions. Regardless of the cytologic preparation method, EUS-FNAC is a useful and accurate diagnostic tool for pancreatic lesions.
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Affiliation(s)
- Soo Hee Ko
- Eulji University School of Medicine, Daejeon 34824, Korea;
| | - Jung-Soo Pyo
- Department of Pathology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea;
| | - Byoung Kwan Son
- Department of Internal Medicine, Nowon Eulji Hospital, Eulji University School of Medicine, Seoul 01380, Korea; (H.Y.L.); (I.W.O.); (K.H.C.)
- Correspondence: ; Tel.: +82-2-970-8204
| | - Hyo Young Lee
- Department of Internal Medicine, Nowon Eulji Hospital, Eulji University School of Medicine, Seoul 01380, Korea; (H.Y.L.); (I.W.O.); (K.H.C.)
| | - Il Whan Oh
- Department of Internal Medicine, Nowon Eulji Hospital, Eulji University School of Medicine, Seoul 01380, Korea; (H.Y.L.); (I.W.O.); (K.H.C.)
| | - Kwang Hyun Chung
- Department of Internal Medicine, Nowon Eulji Hospital, Eulji University School of Medicine, Seoul 01380, Korea; (H.Y.L.); (I.W.O.); (K.H.C.)
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17
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Chun JW, Lee K, Lee SH, Kim H, You MS, Hwang YJ, Paik WH, Ryu JK, Kim YT. Comparison of liquid-based cytology with conventional smear cytology for EUS-guided FNA of solid pancreatic masses: a prospective randomized noninferiority study. Gastrointest Endosc 2020; 91:837-846.e1. [PMID: 31759036 DOI: 10.1016/j.gie.2019.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS There are limited data on the efficacy of liquid-based cytology (LBC) for EUS-guided FNA specimens. We aimed to evaluate the diagnostic efficacy of LBC for solid pancreatic neoplasms compared with conventional smears (CSs). METHODS In this randomized, crossover, noninferiority trial, we randomly assigned (1:1) patients with suspected pancreatic cancer to the LBC group or the CS group. Aspirates from the first needle pass were processed by one method, aspirates from the second pass by the other method, and specimens from the last pass were processed as core biopsy samples. The primary endpoint was the diagnostic efficacy of each method, with the final diagnosis as the gold standard. A noninferiority margin of -10% was assumed. RESULTS Of 170 randomized patients, 165 were classified as malignant and 5 as benign. Unsatisfactory samples were less frequent in the LBC group (1.78%) compared with the CS group (5.33%). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of LBC versus CS were 88.0% versus 83.8% (P = .276), 87.7% versus 83.2% (P = .256), 100% versus 100% (P = .999), 100% versus 100% (P = .999), and 16.7% versus 16.1% (P = .953), respectively. A bloody background was significantly more frequent in the CS group (CS, 85.2%; LBC, 1.8%; P < .001), whereas the nuclear features were similar for both groups. CONCLUSIONS The diagnostic usefulness of LBC was comparable with that of CS. The cytomorphologic features did not differ significantly between the 2 methods, and the reduced bloody backgrounds allowed better visibility in the LBC method. (Clinical trial registration number: NCT03606148.).
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Affiliation(s)
- Jung Won Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Su You
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jung Hwang
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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18
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Zhou W, Gao L, Wang SM, Li F, Li J, Li SY, Wang P, Jia FZ, Xu JJ, Zhou CH, Zou DW, Jin ZD, Wang KX. Comparison of smear cytology and liquid-based cytology in EUS-guided FNA of pancreatic lesions: experience from a large tertiary center. Gastrointest Endosc 2020; 91:932-942. [PMID: 31738926 DOI: 10.1016/j.gie.2019.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Studies comparing the diagnostic efficacy of liquid-based cytology (LBC) and smear cytology (SC) of pancreatic tissue sampling obtained via EUS-guided FNA (EUS-FNA) are still insufficient, mainly because results were controversial. We compared the diagnostic efficiency of LBC and SC of EUS-FNA of pancreatic lesions in one of the largest tertiary hospitals in China. METHODS A retrospective database search (January 2015 to January 2019) was performed for patients who underwent EUS-FNA with both LBC and SC. Demographic, cytologic, and endosonographic data were collected from 819 patients; 514 cases met the inclusion criteria. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were compared. Rapid on-site evaluation was not available in all cases. RESULTS Three hundred eighty-five cases (74.90%) had confirmed malignancy, and 40 cases (7.78%) confirmed benign neoplasm. Adequate tissue sampling rates showed no significant difference between the 2 groups. The sensitivity, accuracy, and negative predictive value (NPV) of LBC were higher than those of SC with statistical significance (71.4% vs 55.1%, 76.1% vs 61.6%, and 40.6% vs 27.7%, respectively). The sensitivity, accuracy, and NPV of combined SC and LBC were higher than those of LBC alone with statistical significance (83.9% vs 71.4%, 86.5% vs 76.1%, and 56.8% vs 40.6%, respectively). Multivariate analysis revealed that pancreatic neck/body/tail lesions (P = .003), solid lesions (P < .001), 22-gauge needle size (P < .001), and number of needle passage >3 (P = .041) were associated with higher diagnostic sensitivity in all participants using LBC, whereas number of needle passage >3 (P = .017) was associated with higher diagnostic sensitivity using SC. CONCLUSIONS LBC was more accurate and sensitive than SC in EUS-FNA of pancreatic lesions with higher NPV when rapid on-site evaluation is unavailable. Pancreatic neck/body/tail lesions, solid lesions, 22-gauge needle, and more than 3 passes were associated with higher sensitivity when using LBC. Performing more than 3 passes is associated with higher sensitivity when using SC.
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Affiliation(s)
- Wei Zhou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Li Gao
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shi-Min Wang
- Medical College of Nantong University, Nantong, China
| | - Feng Li
- Department of Gastroenterology, Christus Trinity Clinic and Hospital, Tyler, Texas, USA
| | - Jun Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shi-Yu Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Peng Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fang-Zhou Jia
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jia-Jia Xu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chun-Hua Zhou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Duo-Wu Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China; Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen-Dong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Kai-Xuan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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19
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van Riet PA, Quispel R, Cahen DL, Snijders-Kruisbergen MC, van Loenen P, Erler NS, Poley JW, van Driel LMJW, Mulder SA, Veldt BJ, Leeuwenburgh I, Anten MPGF, Honkoop P, Thijssen AY, Hol L, Hadithi M, Fitzpatrick CE, Schot I, Bergmann JF, Bhalla A, Bruno MJ, Biermann K. Diagnostic yield and agreement on fine-needle specimens from solid pancreatic lesions : comparing the smear technique to liquid-based cytology. Endosc Int Open 2020; 8:E155-E162. [PMID: 32010748 PMCID: PMC6976322 DOI: 10.1055/a-1038-4103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023] Open
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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Affiliation(s)
- Priscilla A. van Riet
- Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands,Corresponding author P. A. van Riet, MD Dept. of Gastroenterology and HepatologyErasmus MC University Medical Center RotterdamP.O Box 20403015 CE Rotterdamthe Netherlands+31107032908
| | - Rutger Quispel
- Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Djuna L. Cahen
- Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Petri van Loenen
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Nicole S. Erler
- Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Lydi M. J. W. van Driel
- Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Sanna A. Mulder
- Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Bart J. Veldt
- Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Ivonne Leeuwenburgh
- Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands
| | - Marie-Paule G. F. Anten
- Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands
| | - Pieter Honkoop
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annemieke Y. Thijssen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Lieke Hol
- Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Mohammed Hadithi
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Claire E. Fitzpatrick
- Department of Gastroenterology and Hepatology, IJsselland Hospital, Rotterdam, The Netherlands
| | - Ingrid Schot
- Department of Gastroenterology and Hepatology, IJsselland Hospital, Rotterdam, The Netherlands
| | - Jilling F. Bergmann
- Department of Gastroenterology and Hepatology, HAGA, The Hague, The Netherlands
| | - Abha Bhalla
- Department of Gastroenterology and Hepatology, HAGA, The Hague, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands
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20
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Harada R, Kato H, Fushimi S, Inoue H, Uchida D, Akimoto Y, Tomoda T, Matsumoto K, Noma Y, Yamamoto N, Horiguchi S, Tsutsumi K, Okada H. A "Back Light System" for Identification of Sites for Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Solid Pancreatic Masses: A Prospective, Randomized Study with a Crossover Design. Clin Endosc 2019; 52:334-339. [PMID: 31091869 PMCID: PMC6680017 DOI: 10.5946/ce.2019.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background/Aims We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses.
Methods This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information.
Results A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively).
Conclusions The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.
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Affiliation(s)
- Ryo Harada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Soichiro Fushimi
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Hirofumi Inoue
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Daisuke Uchida
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yutaka Akimoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takeshi Tomoda
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Noma
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naoki Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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21
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Diagnostic Efficacy of Liquid-Based Cytology in Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Mass Lesions During the Learning Curve: A Retrospective Study. Pancreas 2019; 48:686-689. [PMID: 31091216 DOI: 10.1097/mpa.0000000000001304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology widely varies depending on the treatment method used. Liquid-based cytology (LBC) has gained popularity in the gynecological field because of its efficacy in collection of target cells and simplicity in the manipulation of specimens. Since the introduction of EUS-FNA at our institution, we have used LBC for the diagnosis of pancreatic mass lesions. This study aims to investigate the diagnostic efficacy of EUS-FNA with LBC in patients with pancreatic mass lesions during the learning curve for EUS-FNA. METHODS In this study, we retrospectively enrolled 222 patients with pancreatic mass lesions who were diagnosed using EUS-FNA with LBC between 2011 and 2016. The diagnostic yields for EUS-FNA with LBC for pancreatic mass lesions were evaluated. RESULTS The diagnostic sensitivity, specificity, and accuracy for malignancy were found to be 93.9%, 95.1%, and 94.1%, respectively. CONCLUSIONS This study suggests that EUS-FNA with LBC for specimens provides good diagnostic efficacy in patients with pancreatic mass lesions even during the learning curve for EUS-FNA.
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22
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Itonaga M, Murata SI, Hatamaru K, Tamura T, Nuta J, Kawaji Y, Maekita T, Iguchi M, Kato J, Kojima F, Yamaue H, Kawai M, Okada KI, Hirono S, Shimokawa T, Tanioka K, Kitano M. Diagnostic efficacy of smear plus liquid-based cytology for EUS-FNA of solid pancreatic lesions: A propensity-matched study. Medicine (Baltimore) 2019; 98:e15575. [PMID: 31083233 PMCID: PMC6531231 DOI: 10.1097/md.0000000000015575] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liquid-based cytology (LBC) is a thin-layer slide preparation procedure that was developed to overcome the cell crowding and contamination associated with smear cytology (SC). The present study compared diagnostic efficacy between SC alone and SC combined with LBC (SLBC) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of pancreatic lesions.We retrospectively analyzed data derived from 311 consecutive patients. Specimens obtained via EUS-FNA from 179 patients between December 2011 and May 2016 were analyzed by SC, and those obtained from 132 patients between June 2016 and October 2017 were analyzed by SLBC. The 2 groups were compared in terms of adequate sample rate, diagnostic accuracy, sensitivity, and specificity using propensity score matching.SC and SLBC were compared using propensity score-matching in 204 patients (n = 102 per group). The adequate sample rate did not differ significantly between SLBC (100%) and SC (99.0%, P = 1). Diagnostic sensitivity, negative predictive value and accuracy were better for SLBC than for SC in terms of cytological (93.2% vs 67.4%, 68.4% vs 23.1%, and 94.1% vs 69.6%, P < .01 each, respectively) and cytohistological (95.5% vs 81.5%, 76.5% vs 34.6%, and 96.1% vs 82.4%, P < .01, P = .02, and P < .01, respectively) analyses.SLBC improves the diagnostic efficacy of EUS-FNA for pancreatic lesions compared to LBC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jun Kato
- Second Department of Internal Medicine
| | | | | | | | | | | | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Kensuke Tanioka
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
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23
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Bang JY, Kirtane S, Krall K, Navaneethan U, Hasan M, Hawes R, Varadarajulu S. In memoriam: Fine-needle aspiration, birth: Fine-needle biopsy: The changing trend in endoscopic ultrasound-guided tissue acquisition. Dig Endosc 2019; 31:197-202. [PMID: 30256458 DOI: 10.1111/den.13280] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Fine-needle aspiration (FNA) cytology has been the preferred technique for procuring tissue at endoscopic ultrasound (EUS) procedures for the past 25 years. To overcome some of the limitations of FNA cytology, fine-needle biopsy (FNB) has been recently developed to yield histological tissue. Main objective was to compare the diagnostic yield of FNB compared to FNA for both onsite and offsite specimen assessment. METHODS A retrospective study was conducted at a single tertiary referral center to evaluate the outcomes of FNA and FNB over a 4-year period. EUS-guided tissue sampling was carried out using 22- or 25-G FNA needles from 2014 to 2015, and 22-G FNB needle was used from 2016 to 2017. RESULTS Of 3020 patients undergoing EUS-guided sampling of solid mass lesions (pancreatic masses 71.3%, other lesions 28.7%), FNA was carried out in 68.9% and FNB in 31.1%. Median number of passes required for diagnostic adequacy on rapid onsite evaluation was significantly lower for FNB compared to FNA (1 [IQR: 1-2] vs 2 [IQR 1-3], P < 0.001). Diagnostic yield on cell block was also significantly superior with FNB compared to FNA (92.3 vs 71.1%, P < 0.001). The superior performance of FNB over FNA was observed for both pancreatic (P < 0.001) and non-pancreatic lesions (P < 0.001). CONCLUSION Given these promising findings, in the future, EUS-guided FNB will likely be the preferred technique for sampling of solid mass lesions.
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Affiliation(s)
- Ji Young Bang
- Center for Interventional Endoscopy, Florida Hospital, Orlando, USA
| | - Sachin Kirtane
- Center for Interventional Endoscopy, Florida Hospital, Orlando, USA
| | - Konrad Krall
- Center for Interventional Endoscopy, Florida Hospital, Orlando, USA
| | | | - Muhammad Hasan
- Center for Interventional Endoscopy, Florida Hospital, Orlando, USA
| | - Robert Hawes
- Center for Interventional Endoscopy, Florida Hospital, Orlando, USA
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24
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Son JH, Park HK, Kim HS, Kim NH, Kim JW, Bae WK, Kim KA, Lee JS, Lee YS. Endoscopic ultrasound-guided fine needle aspiration with liquid-based cytology preparation in the diagnosis of metastatic small-cell carcinoma in the pancreas. Diagn Cytopathol 2018; 46:977-980. [PMID: 30353700 DOI: 10.1002/dc.23990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022]
Abstract
Pancreatic metastasis is extremely rare, particularly from small-cell lung cancer (SCLC). Studies on the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with liquid-based cytology (LBC) in the diagnosis of metastatic small-cell carcinoma in the pancreas have been rarely conducted. We report herein a case of pancreatic metastasis from SCLC diagnosed using EUS-FNA with LBC (ThinPrep). A 71-year-old man presented with chief complaints of hemoptysis and jaundice over the past 1 month. Lung & pancreas tumors with multiple liver nodules were detected on computed tomography. The aspirated material from the pancreas using EUS-FNA was prepared as a cytologic specimen with ThinPrep method, which revealed scattered and clustered "small blue cells" with scant cytoplasm and stippled chromatin with frequent apoptotic bodies. Immunocytochemical staining of the cellblock material revealed strong positivity for CD56 and thyroid transcription factor-1. Endobronchial biopsy for lung mass revealed nests of small, round, blue tumor cells with hyperchromatic nuclei showing salt and pepper chromatin, scant cytoplasm, and brisk mitotic activity. Therefore, a diagnosis of metastatic small-cell carcinoma to the pancreas with an extensive stage was finally made.
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Affiliation(s)
- Jun Hyuk Son
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Han-Seong Kim
- Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Nam-Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Jung Wook Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Won Ki Bae
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Kyung-Ah Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - June Sung Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Yoon Suk Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
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25
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Haseeb A, Taylor LJ, Adler DG. Comparing endoscopic ultrasound-guided core biopsies of solid pancreatic and extrapancreatic lesions: a large single-operator experience with a new fine-needle biopsy needle. Ann Gastroenterol 2018; 31:742-746. [PMID: 30386126 PMCID: PMC6191864 DOI: 10.20524/aog.2018.0313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 02/06/2023] Open
Abstract
Background There has been a paradigm shift in tertiary centers from endoscopic ultrasound (EUS) fine-needle aspiration to EUS fine-needle biopsy (EUS-FNB) for tissue acquisition in solid lesions. While data exists on the use of FNB needles in solid pancreatic lesions, very few studies looked at the utility of FNB in solid extrapancreatic lesions. Our aim was to study and compare the technical success and feasibility of EUS-FNB in evaluating solid pancreatic and extrapancreatic lesions using a novel FNB needle. Methods We performed a retrospective cohort study of patients with solid masses or lesions needing EUS-guided core biopsy at the University of Utah between May 2016 and November 2017. All core biopsies were obtained using an Acquire™Fine Needle Biopsy Device (Boston Scientific Corporation, Natick MA, USA). Rapid on-site evaluation was performed by a board-certified cytopathologist in all cases. Results One hundred thirty-two patients (87 male) were included. Ninety-nine (73.3%) of the lesions were located in the pancreas. All needle sizes (19 G, 22 G and 25 G) had similar yield. The mean number of passes needed was 2.28±0.7. EUS-FNB of the pancreatic lesions had a diagnostic accuracy of 97.9%, comparable to the 97.2% for the biopsied extra-pancreatic lesions. Only 3 of 132 cases needed re-biopsy at a later date. No immediate adverse events were reported. Conclusion In this large, single-center study, EUS-FNB with a novel Franseen-design needle was proven to be an effective modality for tissue acquisition from both pancreatic and extrapancreatic solid lesions.
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Affiliation(s)
- Abdul Haseeb
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Linda Jo Taylor
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Sekita-Hatakeyama Y, Nishikawa T, Takeuchi M, Morita K, Takeda M, Hatakeyama K, Nakai T, Uchiyama T, Itami H, Fujii T, Mitoro A, Sho M, Ohbayashi C. K-ras mutation analysis of residual liquid-based cytology specimens from endoscopic ultrasound-guided fine needle aspiration improves cell block diagnosis of pancreatic ductal adenocarcinoma. PLoS One 2018; 13:e0193692. [PMID: 29494669 PMCID: PMC5832306 DOI: 10.1371/journal.pone.0193692] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/19/2018] [Indexed: 01/17/2023] Open
Abstract
Background Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) technology is widely used for the diagnosis of pancreatic masses. However, in some cases, inadequate tissue volume or difficulty of morphological diagnosis are constraining factors for adequate cytopathological evaluation. K-ras mutation is the most frequently acquired genetic abnormality, occurring in approximately 90% of all patients with pancreatic ductal adenocarcinoma (PDAC). In the present study, the clinical utility of residual liquid-based cytology (LBC) specimens obtained using EUS-FNA for K-ras mutation analysis was evaluated. Methods In this study, 81 patients with pancreatic lesions were examined. The cell block (CB) specimens separated from EUS-FNA samples were morphologically evaluated by hematoxylin–eosin (HE) staining. Final diagnoses were confirmed by CB specimens, surgical resection specimens, diagnostic imaging, and clinical follow-up. Genomic DNA of residual LBC specimens stored at 4°C for several months were extracted and assessed for K-ras mutations using a fluorescence resonance energy transfer-based preferential homoduplex formation assay. Results K-ras mutation analysis using residual LBC samples was successful in all cases. The sensitivity, specificity, and accuracy of CB examination alone were 77.4%, 100%, and 81.3%, respectively, and those of the combination of CB examination and K-ras mutation analysis were 90.3%, 92.3%, and 90.7%, respectively. Furthermore, K-ras mutations were detected in 8 (57.1%) of 14 PDAC samples for which the CB results were inconclusive. Conclusion These findings suggest that K-ras mutation analysis using residual LBC specimens improves the diagnostic accuracy of EUS-FNA.
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Affiliation(s)
| | - Takeshi Nishikawa
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Mao Takeuchi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Kouhei Morita
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
- * E-mail:
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
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27
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Mohanty SK, Pradhan D, Sharma S, Sharma A, Patnaik N, Feuerman M, Bonasara R, Boyd A, Friedel D, Stavropoulos S, Gupta M. Endoscopic ultrasound guided fine-needle aspiration: What variables influence diagnostic yield? Diagn Cytopathol 2017; 46:293-298. [PMID: 29280329 DOI: 10.1002/dc.23883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 07/09/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) plays an important role in the diagnosis of various lesions. We sought to determine factors that influence the diagnostic yield of EUS-FNA, specifically, the presence of a cytopathologist, FNA site, and the endoscopist's skill. METHODS The data on cytopathologist's availability, duration of procedure, number of passes made, and diagnostic material for cell block (CB) preparation was collected over an 18 months period. RESULTS 230 specimens (218 patients) were obtained from pancreas (114), lymph node (64), submucosal lesions of the gastrointestinal tract (27), liver (8), and miscellaneous (17) sites. The results were classified as informative (77.8%) and non-informative (NI) (22.2%). The NI rate was significantly high, when a cytopathologist was absent (P = .0008). As the likelihood of cytopathologist's presence increased from 35.8% to 82.9%, the CB quality increased (P < .0001). In the absence of a cytopathologist, the likelihood of NI result increased more than 2-fold (P = .03) and of an inadequate CB increased 3-fold (P < .0001). The more experienced endoscopist "C" (compared to the less experienced "A + B") was less likely to get inadequate material (40.5% vs. 66.3%) (P = .0001). CONCLUSION The diagnostic yield of EUS-FNA is significantly related to the presence of an on-site cytopathologist and endoscopist's skill in procuring diagnostic material.
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Affiliation(s)
- Sambit K Mohanty
- Department of Pathology, Winthrop University Hospital, Mineola, New York.,Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Dinesh Pradhan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Anurag Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Niharika Patnaik
- Department of Pathology, Kalinga hospital, Bhubaneswar, Odisha, India
| | - Martin Feuerman
- Department of Biostatistics, Winthrop University Hospital, Mineola, New York
| | - Robert Bonasara
- Department of Gastroenterology, Winthrop University Hospital, Mineola, New York
| | - Adrienne Boyd
- Department of Pathology, Winthrop University Hospital, Mineola, New York
| | - David Friedel
- Department of Biostatistics, Winthrop University Hospital, Mineola, New York
| | | | - Mala Gupta
- Department of Pathology, Winthrop University Hospital, Mineola, New York
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28
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Bernardes C, Carvalho D, Ramos G. Liquid-based cytology for the diagnosis of solid pancreatic tumors with endoscopic ultrasound-guided fine-needle aspiration: Can we dismiss conventional smear? Dig Endosc 2017; 29:814. [PMID: 28672062 DOI: 10.1111/den.12915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Carlos Bernardes
- Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, Portugal
| | - Diana Carvalho
- Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, Portugal
| | - Gonçalo Ramos
- Gastroenterology Department, Centro Hospitalar de Lisboa Central, Nova Medical School - Faculty of Medical Sciences, Lisbon, Portugal
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