Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: a systematic review and meta-analysis

Pancreatology. 2014 Sep-Oct;14(5):380-4. doi: 10.1016/j.pan.2014.07.006. Epub 2014 Jul 22.

Abstract

Objectives: Differential 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.

Methods: Relevant 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.

Results: Four 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.

Conclusions: EUS-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.

Keywords: Cytology; Endoscopic ultrasound-guided fine-needle aspiration; Intraductal papillary mucinous neoplasm; Malignancy; Meta-analysis; Pancreatic cystic lesion.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adenoma / diagnostic imaging
  • Adenoma / pathology*
  • Carcinoma in Situ / diagnostic imaging
  • Carcinoma in Situ / pathology*
  • Carcinoma, Pancreatic Ductal / diagnostic imaging
  • Carcinoma, Pancreatic Ductal / pathology*
  • Diagnosis, Differential
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration*
  • Humans
  • Likelihood Functions
  • Pancreas / diagnostic imaging
  • Pancreas / pathology*
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology*
  • Sensitivity and Specificity