Does EUSFNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Gillis, Amy; Cipollone, Ilaria; Cousins, Grainne; Conlon, Kevin
• Is Part Of: HPB. Volume 17:Issue 5(2015:May)
• Page Start: 377
• Page End: 386
• Publication Date: 2015-05
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12364
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Endoscopic ultrasonography with fine needle aspiration (EUSFNA) has become an integral tool in the diagnosis of pancreatic cystic lesions (PCLs) and the analysis of molecular/DNA abnormalities might improve the accuracy of preoperative diagnosis. A review was conducted of all studies using EUSFNA aspirates of PCLs to assess the accuracy and added benefit that molecular analysis provides to cytological analysis. Methods: A systematic review of the literature was conducted using PRISMA guidelines and electronic databases: PubMed/SCOPUS/EMBASE/Cochrane/CINAHL. Surgical pathology was used as the definitive reference standard. The QUADAS2 tool was used for quality assessment. Results: In total, 162 articles were identified; 12 articles met inclusion/exclusion criteria. Ten studies reported on cytology and 8 studies reported kras mutational analysis. 362 patients (of 1115 total) had surgical pathology available. The sensitivity and specificity of cytology was 0.42 and 0.99; the sensitivity and specificity of kras was 0.39 and 0.95; and the sensitivity and specificity of the combined test of cytology and kras was 0.71 and 0.88, respectively. Conclusions: kras mutational analysis used as an individual screening test has a poor diagnostic accuracy, as does cytology when used alone. The benefit comes with utilization in a combined fashion. More studies are needed to evaluate the correct sequence and utility of these tests for cyst differentiation.