Diagnostic efficiency of image-guided fine-needle aspiration cytology for the evaluation of pancreatic mass lesions: a study based on the Papanicolaou Society of Cytopathology guidelines

Abstract

Background Pancreatic cytology can actually make a difference in patients’ management. The Papanicolaou Society of Cytopathology has submitted new regulations for pancreatico–biliary cytology bringing up indications, methodologies, terminology, auxiliary tests, and postprocedural management.Objective This study aimed to determine the sensitivity, specificity, and positive and negative predictive values of image-guided fine-needle aspiration cytology (FNAC) in the evaluation of pancreatic masses, detect diagnostic pitfalls, and attempt to find explanations for these pitfalls.Materials and methods In this study, a retrospective review was performed of 139 cases of pancreatic lesions that were subjected to image-guided FNAC with subsequent correlation with histological diagnosis or clinic–radiological data between January 2013 and March 2016 in the Cytology Unit, Pathology Department, National Cancer Institute, Cairo University. Cytological diagnoses were stratified into six categories: (i) nondiagnostic, (ii) negative, (iii) atypical, (iv) neoplastic: benign or others, (v) suspicious, and (vi) malignant.Results The mean age was 54.09±12.8 years. After excluding nondiagnostic cases and the atypical case and in reference to histological diagnoses and clinic–radiological findings, 86.5% of cases were true-positive; 11.9% of cases were true-negative; 0.8% of cases were false-negative; and 0.8% of cases were false-positive. As a result, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the pancreatic cytology were 99.09, 93.75, 99.09, 93.75, and 98.41, respectively.Conclusion FNAC has high accuracy, sensitivity, and specificity in the diagnosis of pancreatic lesions, especially pancreatic adenocarcinoma, which may influence the treatment plans.