Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 3006-3020
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.3006
Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis
Hang-Hai Pan, Xin-Xin Zhou, Fei Zhao, Hui-Yan Chen, Yu Zhang
Hang-Hai Pan, Fei Zhao, Yu Zhang, Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Xin-Xin Zhou, Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Hui-Yan Chen, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
Author contributions: Pan HH and Zhou XX contributed to the acquisition, analysis, and interpretation of the data and drafted the manuscript; Zhao F and Chen HY contributed to the interpretation of the data and revised the manuscript; Zhang Y contributed to the conception and design of the study and critically revised the manuscript; all authors approved the final manuscript.
Supported by the Natural Science Foundation of Zhejiang Province, No. LQ20H160061; Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2018255969.
Conflict-of-interest statement: No potential conflicts of interest exist.
PRISMA 2009 Checklist statement: The manuscript was prepared according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu Zhang, MD, Doctor, Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No. 158, Shangtang, Hangzhou 310014, Zhejiang Province, China. xxxzzzyyy@foxmail.com
Received: March 13, 2020
Peer-review started: March 13, 2020
First decision: April 12, 2020
Revised: April 25, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 26, 2020
ARTICLE HIGHLIGHTS
Research background

Smear cytology (SC) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the established and traditional choice for diagnosing pancreatic lesions. Liquid-based cytology (LBC) is a novel alternative cytological method, however, the comparative diagnostic efficacy of LBC remains inconclusive.

Research motivation

Although previous studies have reported that use of LBC for pancreatic EUS-FNA specimens is acceptable, to what extent we can trust the results of LBC and whether it is feasible to use LBC alone or whether LBC should be used in combination with SC are unclear aspects. Further, cumulative evidence in the form of systematic review and meta-analysis of the studies is unavailable.

Research objectives

To perform a systematic review and meta-analysis on comparative diagnostic efficacy of LBC and SC for pancreatic specimens obtained by EUS-FNA.

Research methods

A systematic literature search was performed using PubMed, EMBASE, the Cochrane Library, and Web of Science. The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve (AUC) were calculated, and the AUC was compared by Tukey's multiple comparisons test.

Research results

A total of 1656 patients in eight studies were included. The pooled sensitivity and specificity and the AUC for LBC were 0.76 (95%CI: 0.72-0.79), 1.00 (95%CI: 0.98-1.00), and 0.9174, respectively, for diagnosing pancreatic lesions. The pooled estimates for SC were as follows: Sensitivity, 0.68 (95%CI: 0.64-0.71); specificity, 0.99 (95%CI: 0.96-100.00); and AUC, 0.9714. Similarly, the corresponding values for LBC combined with SC were 0.87 (95%CI: 0.84-0.90), 0.99 (95%CI: 0.96-1.00), and 0.9894. The results revealed a higher sensitivity of LBC than SC in the diagnosis of benign and malignant pancreatic lesions. Additionally, the diagnostic performance of LBC combined with SC was higher than that of LBC or SC, alone (P < 0.05).

Research conclusions

LBC may have a superior sensitivity to SC in the diagnosis of benign and malignant pancreatic lesions. The diagnostic performance of LBC combined with SC is significantly better than that of LBC or SC, alone.

Research perspectives

Our study found superior outcomes of LBC combined with SC performed in pancreatic lesions. These findings suggest that we should promote the combined use of these two techniques to guide clinical practice. Additionally, with the continuous progress of EUS-FNA technology, the advantages of LBC may be further revealed. Moreover, future research studies should assess the differences between solid and cystic pancreatic lesions to confirm our results.