Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Department of Oncology Pathology, Department of Pathology and Host-Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Cytopathology. 2022 Mar;33(2):206-215. doi: 10.1111/cyt.13076. Epub 2021 Nov 26.
Cytological diagnosis of pancreatic specimens obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is often challenging because of the small sample size or well-differentiated adenocarcinoma with weak cytological atypia. Therefore, the sensitivity and specificity of cytological diagnosis for pancreatic cancer should be improved. Hence, we aimed to clarify the utility of cytological scoring to distinguish malignant from benign lesions for cytological diagnosis of pancreatic EUS-FNA specimens.
Seven reviewers, including four cytotechnologists and three medical doctors, evaluated 20 morphological indices in pancreatic specimens obtained by EUS-FNA (malignant, n = 111; benign, n = 31). Statistical analyses were performed using Fisher's exact test, logistic regression analysis, the area under the receiver operating characteristic curve, and Youden index.
Among the 20 indices, there was a high incidence rate (>40%) of the following 13 indices in malignant cases: irregular structure, hyperchromatic nucleus, irregular cell polarity, unclear cell boundaries, nuclear membrane thickening, anisonucleosis, overlapping, irregular nuclei, high nuclear-cytoplasmic ratio, binding decline, the simultaneous appearance of malignant and benign cells, enlarged nucleoli, and background necrosis. When we diagnosed pancreatic specimens using these 13 cytological indices, the cut-off value of 8/9 showed the highest Youden index (0.950) as well as high sensitivity and specificity in distinguishing malignant from benign specimens (98% and 97%, respectively).
Thirteen cytological indices showed high sensitivity and specificity in differentiating malignant and benign lesions using pancreatic EUS-FNA samples. All 13 indices were important for diagnosing malignancy in the pancreatic cytology smear of EUS-FNA. Further validation studies are required.
经内镜超声引导下细针抽吸术（EUS-FNA）获取的胰腺标本进行细胞学诊断往往具有挑战性，因为标本体积小或分化良好的腺癌细胞具有较弱的细胞学异型性。因此，需要提高细胞学诊断对胰腺癌的敏感性和特异性。因此，我们旨在阐明细胞学评分在区分良恶性病变方面的效用，以提高对 EUS-FNA 胰腺标本的细胞学诊断。
7 位审阅者（包括 4 位细胞技术专家和 3 位医生）评估了 EUS-FNA 获得的 20 个胰腺标本的形态学指标（恶性，n=111；良性，n=31）。使用 Fisher 精确检验、逻辑回归分析、受试者工作特征曲线下面积和 Youden 指数进行统计学分析。
在 20 个指标中，恶性病例中存在 13 个发生率较高（>40%）的指标：不规则结构、深染核、不规则细胞极性、不清楚的细胞边界、核膜增厚、核大小不均、重叠、不规则核、核浆比高、结合下降、恶性和良性细胞同时出现、核仁增大和背景坏死。当我们使用这 13 个细胞学指标诊断胰腺标本时，8/9 的截断值表现出最高的 Youden 指数（0.950），并具有高的敏感性和特异性，可区分良恶性标本（分别为 98%和 97%）。
13 项细胞学指标在区分胰腺 EUS-FNA 样本中的良恶性病变方面具有较高的敏感性和特异性。所有 13 项指标对于 EUS-FNA 胰腺细胞学涂片的恶性诊断均具有重要意义。需要进一步的验证研究。
