Post written by Sang Hyub Lee, MD, PhD, and Haeryoung Kim, MD, PhD, from the Department of Internal Medicine and Liver Research Institute, and the Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

The purpose of this study was to evaluate the diagnostic performance of liquid-based cytology for diagnosing pancreatic cancer on EUS-FNA specimens in comparison with conventional smears.

EUS-FNA is now a widely used diagnostic tool for pancreatic cancers, and maximizing the diagnostic yield from the tiny amount of aspirated material is of critical importance in the management of patients with this lethal disease. Although the conventional smear is the most common method for processing EUS-FNA material, it often results in bloody smears, dry artifacts, crushing artifacts and thick tissue fragments, which can obscure the cytological features and result in a suboptimal diagnosis. Liquid-based cytology is being increasingly used for a wide variety of cytology specimens, but there is still limited data regarding the diagnostic efficacy of this method for pancreatic cancer.

What we did in this randomized, crossover, non-inferiority trial, single-center study was that we evaluated the diagnostic performance of SurePath liquid-based cytology for diagnosing pancreatic cancers on EUS-FNA specimens from 170 subjects in comparison with conventional smears.

We found that 1) the diagnostic accuracy and sensitivity of liquid-based cytology and conventional smears were similar and 2) the diagnostic performance of liquid-based cytology was further enhanced when combined with core biopsies.

In addition to that, the cytomorphological features of ductal adenocarcinomas were similar on liquid-based cytology and conventional smears, and liquid-based cytology slides demonstrated significantly reduced bloody backgrounds and less frequent inadequate specimens compared to conventional smears.

Rapid on-site evaluation has been shown to improve the diagnostic yield of EUS-FNA specimens. However, this system is not available in many parts of the world for various reasons, including limited medical resources. Because specimen adequacy is a very important issue, we think the results of our study could be quite encouraging for both endoscopists and cytopathologists, especially in institutions where rapid on-site evaluation is not feasible.

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