Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2021; 9(14): 3308-3319
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3308
Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis
Xiao-Hui Zhang, Shi-Yang Ma, Na Liu, Zhong-Cao Wei, Xu Gao, Yu-Jie Hao, Yi-Xin Liu, Ya-Qin Cai, Jin-Hai Wang
Xiao-Hui Zhang, Shi-Yang Ma, Na Liu, Zhong-Cao Wei, Xu Gao, Yu-Jie Hao, Yi-Xin Liu, Ya-Qin Cai, Jin-Hai Wang, Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Author contributions: Zhang XH and Wang JH designed the research study; Zhang XH and Wei ZC screened the articles and extracted the data; Zhang XH, Liu YX, and Cai YQ compiled the tables and figures; Zhang XH, Gao X, and Hao YJ analyzed the data; Zhang XH wrote the manuscript; Ma SY and Liu N critically modified the content of the article; All authors have read and approve the final manuscript.
Conflict-of-interest statement: No potential conflicts of interest exist.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised 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: Jin-Hai Wang, MD, Doctor, Professor, Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West Fifth Road, Xi'an 710004, Shaanxi Province, China. jinhaiwang@hotmail.com
Received: November 12, 2020
Peer-review started: November 12, 2020
First decision: January 23, 2021
Revised: January 30, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: May 16, 2021
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.

Keywords: Smear cytology, Liquid-based cytology, Pancreas, Endoscopic ultrasonography-guided fine-needle aspiration, Sensitivity and specificity, Diagnostic efficacy

Core Tip: Numerous studies comparing the diagnostic efficacy of smear cytology and liquid-based cytology (LBC) for endoscopic ultrasonography-guided fine-needle aspiration in pancreatic lesions yielded mixed results. Therefore, we conducted this systematic review and meta-analysis, finding that for endoscopic ultrasonography-guided fine-needle aspiration in pancreatic lesions (particularly solid lesions), smear cytology 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.