The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta‐analysis

Abstract

ObjectiveA meta‐analysis has not been previously performed to evaluate critically the diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) of solely pancreatic ductal adenocarcinoma and address factors that have an impact on variability of accuracy. The aim of this study was to determine whether the presence of a cytopathologist, variability of the reference standard and other sources of heterogeneity significantly impacts diagnostic accuracy.MethodsWe conducted a comprehensive search to identify studies, in which the pooled sensitivity, specificity, likelihood ratios for a positive or negative test (LR+, LR−) and summary receiver‐operating curves (SROC) could be determined for EUS‐FNA of the pancreas for ductal adenocarcinoma using clinical follow‐up, and/or surgical biopsy or excision as the reference standard.ResultsWe included 34 distinct studies (3644 patients) in which EUS‐FNA for a solid pancreatic mass was evaluated. The pooled sensitivity and specificity for EUS‐FNA for pancreatic ductal adenocarcinoma was 88.6% [95% confidence interval (CI): 87.2–89.9] and 99.3% (95% CI: 98.7–99.7), respectively. The LR+ and LR– were 33.46 (95% CI: 20.76–53.91) and 0.11 (95% CI: 0.08–0.16), respectively. The meta‐regression model showed rapid on‐site evaluation (ROSE) (P = 0.001) remained a significant determinant of EUS‐FNA accuracy after correcting for study population number and reference standard.ConclusionEUS‐FNA is an effective modality for diagnosing pancreatic ductal adencarcinoma in solid pancreatic lesions, with an increased diagnostic accuracy when using on‐site cytopathology evaluation.