Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.3006
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
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.
Although previous studies have reported that use of LBC for pancreatic EUS-FNA specimens is acceptable, to what extent we can trust the results of LBC and whether it is feasible to use LBC alone or whether LBC should be used in combination with SC are unclear aspects. Further, cumulative evidence in the form of systematic review and meta-analysis of the studies is unavailable.
To perform a systematic review and meta-analysis on comparative diagnostic efficacy of LBC and SC for pancreatic specimens obtained by EUS-FNA.
A systematic literature search was performed using PubMed, EMBASE, the Cochrane Library, and Web of Science. 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.
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. The results 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).
LBC may have a superior sensitivity to SC in the diagnosis of benign and malignant pancreatic lesions. The diagnostic performance of LBC combined with SC is significantly better than that of LBC or SC, alone.
Our study found superior outcomes of LBC combined with SC performed in pancreatic lesions. These findings suggest that we should promote the combined use of these two techniques to guide clinical practice. Additionally, with the continuous progress of EUS-FNA technology, the advantages of LBC may be further revealed. Moreover, future research studies should assess the differences between solid and cystic pancreatic lesions to confirm our results.