Diagnostic yield and agreement on fine-needle specimens from solid pancreatic lesions: comparing the smear technique to liquid-based cytology

Priscilla A. van Riet; Rutger Quispel; Djuna L. Cahen; Mieke C. Snijders-Kruisbergen; Petri van Loenen; Nicole S. Erler; Jan-Werner Poley; Lydi M. J. W. van Driel; Sanna A. Mulder; Bart J. Veldt; Ivonne Leeuwenburgh; Marie-Paule G. F. Anten; Pieter Honkoop; Annemieke Y. Thijssen; Lieke Hol; Mohammed Hadithi; Claire E. Fitzpatrick; Ingrid Schot; Jilling F. Bergmann; Abha Bhalla; Marco J. Bruno; Katharina Biermann

doi:10.1055/a-1038-4103

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(02): E155-E162
DOI: 10.1055/a-1038-4103

Original article

Diagnostic yield and agreement on fine-needle specimens from solid pancreatic lesions: comparing the smear technique to liquid-based cytology

Priscilla A. van Riet

¹Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Rutger Quispel

²Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands

,

Djuna L. Cahen

¹Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Mieke C. Snijders-Kruisbergen

³Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Petri van Loenen

³Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Nicole S. Erler

⁴Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Jan-Werner Poley

¹Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Lydi M. J. W. van Driel

²Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands

,

Sanna A. Mulder

²Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands

,

Bart J. Veldt

²Deparment of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands

,

Ivonne Leeuwenburgh

⁵Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands

,

Marie-Paule G. F. Anten

⁵Department of Gastroenterology and Hepatology, Sint Franciscus Hospital, Rotterdam, The Netherlands

,

Pieter Honkoop

⁶Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands

,

Annemieke Y. Thijssen

⁶Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands

,

Lieke Hol

¹Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Mohammed Hadithi

⁷Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands

,

Claire E. Fitzpatrick

⁸Department of Gastroenterology and Hepatology, IJsselland Hospital, Rotterdam, The Netherlands

,

Ingrid Schot

⁸Department of Gastroenterology and Hepatology, IJsselland Hospital, Rotterdam, The Netherlands

,

Jilling F. Bergmann

⁹Department of Gastroenterology and Hepatology, HAGA, The Hague, The Netherlands

,

Abha Bhalla

⁹Department of Gastroenterology and Hepatology, HAGA, The Hague, The Netherlands

,

Marco J. Bruno‡^*

¹Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, the Netherlands

,

Katharina Biermann‡^*

³Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands

› Author Affiliations

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.

Full Text

References

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