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The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound‐guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta‐analysis
Author(s) -
HébertMagee S.,
Bae S.,
Varadarajulu S.,
Ramesh J.,
Frost A. R.,
Eloubeidi M. A.,
Eltoum I. A.
Publication year - 2013
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12071
Subject(s) - medicine , fine needle aspiration , cytopathology , radiology , adenocarcinoma , endoscopic ultrasound , receiver operating characteristic , diagnostic accuracy , biopsy , cytology , pancreatic ductal adenocarcinoma , pancreas , pancreatic mass , confidence interval , meta analysis , gold standard (test) , pancreatic cancer , pathology , cancer
Objective A 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. Methods We 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. Results We 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. Conclusion EUS ‐ 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.