Liu Fu-Qiang, Ren Li-Na, Lu Qin, Xiao Ling, Li Xue-Qin, Liu Wei-Hui
Department of Gastroenterology and Hepatology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China.
Department of Gastroenterology, Jianyang People's Hospital, Jianyang, Sichuan Province, China.
Dig Dis Sci. 2025 Sep 25. doi: 10.1007/s10620-025-09409-w.
Studies comparing the diagnostic efficacy of histology combined with smear cytology (SC) and liquid-based cytology (LBC) in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of solid pancreatic lesions are limited, mainly due to the ongoing debate about the need for simultaneous use of SC and LBC as adjuncts to histology. We aimed to evaluate the diagnostic efficacy of combining histology with single cytology in EUS-FNA of solid pancreatic lesions.
We retrospectively searched hospital database from January 2021 to December 2023 to identify patients who underwent EUS-FNA with concomitant histology, SC and LBC. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under curve (AUC) of the above methods were compared. The primary endpoint was the diagnostic efficacy of each method, with the final diagnosis confirmed by surgical pathology, or clinical follow-up.
Of the 293 patients included, 236 were malignant and 57 were benign. Histology alone demonstrated a higher diagnostic performance than either SC or LBC. Combining histology with either SC or LBC improved sensitivity, but reduced specificity. No significant increase in diagnostic efficacy was observed when combining histology with both cytological methods. Additionally, SC with more than 8 smears showed higher sensitivity and accuracy than LBC.
EUS-FNA histology only requires combination with one cytological method (either SC or LBC), rather than both methods, to improve diagnostic accuracy for solid pancreatic lesions, meet clinical diagnostic requirements, and achieve high cost-effectiveness.
比较组织学联合涂片细胞学检查（SC）和液基细胞学检查（LBC）在内镜超声引导下对实性胰腺病变进行细针穿刺活检（EUS-FNA）的诊断效能的研究有限，主要原因是对于是否需要同时使用SC和LBC作为组织学检查的辅助手段仍存在争议。我们旨在评估在实性胰腺病变的EUS-FNA中组织学联合单一细胞学检查的诊断效能。
我们回顾性检索了2021年1月至2023年12月的医院数据库，以确定接受了EUS-FNA并同时进行组织学、SC和LBC检查的患者。比较了上述方法的诊断准确性、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。主要终点是每种方法的诊断效能，最终诊断通过手术病理或临床随访确认。
在纳入的293例患者中，236例为恶性，57例为良性。单独的组织学检查显示出比SC或LBC更高的诊断性能。组织学联合SC或LBC均可提高敏感性，但降低特异性。当组织学与两种细胞学方法联合时，未观察到诊断效能的显著提高。此外，涂片超过8张的SC显示出比LBC更高的敏感性和准确性。
对于实性胰腺病变，EUS-FNA组织学检查仅需联合一种细胞学方法（SC或LBC），而非两种方法，即可提高诊断准确性，满足临床诊断需求，并实现高性价比。
