Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 3006-3020
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.3006
Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis
Hang-Hai Pan, Xin-Xin Zhou, Fei Zhao, Hui-Yan Chen, Yu Zhang
Hang-Hai Pan, Fei Zhao, Yu Zhang, 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
Hui-Yan Chen, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
Author contributions: Pan HH and Zhou XX contributed to the acquisition, analysis, and interpretation of the data and drafted the manuscript; Zhao F and Chen HY contributed to the interpretation of the data and revised the manuscript; Zhang Y contributed to the conception and design of the study and critically revised the manuscript; all authors approved the final manuscript.
Supported by the Natural Science Foundation of Zhejiang Province, No. LQ20H160061; Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2018255969.
Conflict-of-interest statement: No potential conflicts of interest exist.
PRISMA 2009 Checklist statement: The manuscript was prepared according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu Zhang, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158, Shangtang, Hangzhou 310014, Zhejiang Province, China. xxxzzzyyy@foxmail.com
Received: March 13, 2020
Peer-review started: March 13, 2020
First decision: April 12, 2020
Revised: April 25, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 26, 2020
Processing time: 132 Days and 21.8 Hours
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.

Keywords: Liquid-based cytology; Smear cytology; Pancreatic lesions; Endoscopic ultrasound-guided fine needle aspiration; Cytological diagnosis; ROC curve

Core tip: This systematic review and meta-analysis examined the comparative diagnostic efficacy of liquid-based cytology (LBC) and smear cytology (SC) using endoscopic ultrasound-guided fine needle aspiration in diagnosing pancreatic lesions. The pooled analyses of 1656 patients from eight studies performed herein, using only comparative test accuracy studies, revealed a higher sensitivity of LBC than SC in the diagnosis of benign and malignant pancreatic lesions. Additionally, the diagnostic performance of LBC combined with SC was higher than that of LBC or SC, alone (P < 0.05). We recommend the combined use of LBC and SC in the evaluation of pancreatic lesions.