Department of Internal Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, USA.
Dig Dis Sci. 2010 Oct;55(10):2756-66. doi: 10.1007/s10620-010-1361-8. Epub 2010 Aug 6.
Preoperative diagnosis of malignancy in pancreatic cystic lesions (PCLs) remains challenging. Most non-mucinous cystic lesions (NMCLs) are benign, but mucinous cystic lesions (MCLs) are more likely to be premalignant or malignant.
The aim of this study was to assess the sensitivity, specificity, and positive and negative likelihood ratios (LRs) of EUS-FNA-based cytology in differentiating MCLs from non-mucinous PCLs.
We conducted a comprehensive search of MEDLINE, SCOPUS, Cochrane, and "CINAHL Plus" databases to identify studies, in which the results of EUS-FNA-based cytology of PCLs were compared with those of surgical biopsy or surgical excision histopathology. A DerSimonian-Laird random effect model was used to estimate the pooled sensitivity, specificity, and LRs, and a summary receiver-operating characteristic (SROC) curve was constructed.
We included 376 patients from 11 distinct studies who underwent EUS-FNA-based cytology and also had histopathological diagnosis. The pooled sensitivity and specificity in diagnosing MCLs were 0.63 (95% CI, 0.56-0.70) and 0.88 (95% CI, 0.83-0.93), respectively. The positive and negative LRs in diagnosing MCLs were 4.46 (95% CI, 1.21-16.43) and 0.46 (95% CI, 0.25-0.86), respectively. The area under the curve (AUC) was 0.89.
EUS-FNA-based cytology has overall low sensitivity but good specificity in differentiating MCLs from NMCLs. Further research is required to improve the overall sensitivity of EUS-FNA-based cytology to diagnose MCLs while evaluating PCL.
胰腺囊性病变（PCL）术前恶性肿瘤的诊断仍然具有挑战性。大多数非黏液性囊性病（NMCL）是良性的，但黏液性囊性病（MCL）更有可能是癌前病变或恶性的。
本研究旨在评估超声内镜引导下细针抽吸活检（EUS-FNA）细胞学检查在鉴别 MCL 与非黏液性 PCL 中的敏感性、特异性、阳性和阴性似然比（LR）。
我们对 MEDLINE、SCOPUS、Cochrane 和“CINAHL Plus”数据库进行了全面检索，以确定比较 PCL 超声内镜引导下细针抽吸活检细胞学结果与手术活检或手术切除组织病理学结果的研究。采用 DerSimonian-Laird 随机效应模型估计汇总敏感性、特异性和 LR，并构建汇总受试者工作特征（SROC）曲线。
我们纳入了 11 项不同研究的 376 例患者，这些患者均接受了超声内镜引导下细针抽吸活检，并且均有组织病理学诊断。诊断 MCL 的汇总敏感性和特异性分别为 0.63（95%可信区间，0.56-0.70）和 0.88（95%可信区间，0.83-0.93）。诊断 MCL 的阳性和阴性 LR 分别为 4.46（95%可信区间，1.21-16.43）和 0.46（95%可信区间，0.25-0.86）。曲线下面积（AUC）为 0.89。
超声内镜引导下细针抽吸活检细胞学检查在鉴别 MCL 与 NMCL 方面总体敏感性较低，但特异性较好。需要进一步研究以提高超声内镜引导下细针抽吸活检细胞学检查诊断 MCL 的总体敏感性，同时评估 PCL。
