Iranian Journal of Pathology

Diagnostic Value of Cytology in Pancreatic Endoscopic Ultrasound-Guided Fine Needle Aspiration: Accuracy in Common Epithelial Pancreatobiliary Tumors and the Role of Cell Block Analysis

Document Type : Original Research

Authors

Naser Rakhshani 1
Neda Soleimani 2
Sanaz Aghaei 3
Rasha Barakat 2
Ali Mohammad Keshtvarz Hesam Abadi 4

1 Department of Pathology, Gastrointestinal and liver disease Research center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Pathology, Iran Medical School, Iran University of Medical Sciences, Tehran, Iran

4 Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran

https://doi.org/10.30699/ijp.2024.2036290.3329
Abstract
Background & Objective: Limited literature describes the accuracy of endoscopic ultrasonography–fine needle aspiration (EUS-FNA) cytology in various types of pancreatic epithelial tumors, and this underscores the usefulness of cell blocks, and highlights potential diagnostic pitfalls.  
Methods: This study included 108 patients who underwent EUS-FNA pancreatobiliary cytology followed by surgery. Age, gender, tumor location, tumor size, presence or absence of a cell block, cytologic and pathologic diagnoses, and histologic tumor grade were recorded. Cytologic and pathologic slides were examined, and the cytologic accuracy was determined by comparing cytologic with the histopathologic results as the gold standard. Additionally, the impact of cell block on the cytologic accuracy was assessed.
Results: EUS-FNA cytology showed an overall accuracy of 80%, a sensitivity of 90%, and a false-positive rate below 1%. Pancreatic ductal adenocarcinomas (PDAs) accounted for 65% of cases, followed by neuroendocrine tumors (NETs), solid pseudopapillary neoplasms (SPNs), mucinous cystic neoplasms (MCNs), and chronic pancreatitis. Diagnostic accuracy was higher for PDA and SPN than for NET and MCN and significantly improved to 100% in cases with a cell block.
Conclusion: Combining pancreatobiliary cytology with a cell block significantly enhances diagnostic accuracy, reaching 100%. Moreover, poorly differentiated PDAs and well-differentiated organoid-type tumors, such as NETs and SPNs, demonstrate higher diagnostic accuracy. 

Highlights

  • The diagnostic accuracy of cytology was higher with PDA and SPN than with NET and MCN and rose significantly in cases with cell block.
  • FNA cytology detected PDA more accurately as the tumor grade decreased; however, for NETs, accuracy declined with poor tumor differentiation.
  • In cases where cytology and pathology disagreed, missing tumor locations, small tumor size, tumor necrosis, and very good differentiation in PDA and cystic degeneration, papillary architecture, pleomorphism, and ganglion cells in NETs were the most frequent causes of pitfalls.

Keywords

Accuracy
Cytology
EUS-FNA
Pancreatic adenocarcinoma
Pancreatobiliary

Subjects

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Iranian Journal of Pathology
Volume 20, Issue 1
Winter 2025
Pages 98-107

  • Receive Date 21 July 2024
  • Revise Date 20 August 2024
  • Accept Date 07 December 2024

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