Etecp cytology and EUS-FNA cytology in the diagnosis of malignant distal biliary and pancreatic duct strictures

ABSTRACT

Endoscopic retrograde cholangio-pancreatography [ERCP] with ductal brushings and pancreatic juice cytology is widely used in suspected pancreatic cancer, despite its low sensitivity. In contrast the accuracy rates of endoscopic ultrasound [EUS]-fine needle aspiration [FNA] for diagnosis of pancreatic malignancy is high. Aim of the study To compare diagnostic performance of ERCP cytology [ERCP-C] with EUS-FNA in suspected patients with malignant pancreatic duct stricture. Patients and A prospective study included 56 patients with pancreatic duct stricture was performed. ERCP-C and EUS-FNA were carried out for cytopathological diagnosis. The final diagnosis was pancreatic malignancy in 60.7% patients and benign pancreatic disease in 39.3% patients. The sensitivity, specificity, positive [PPV] and negative [NPV] predictive values and accuracy of EUS-FNA for malignant pancreatic ductal stricture were 87.9%, 100%, 100%, 84.6% and 92.7, respectively. The sensitivity, specificity, PPV, NP V, and accuracy of ERCP brush cytology alone [41.4%, 100%, 100%, 55.3%, 66%, respectively], and combined with pancreatic juice cytology [48.3%, 100%, 100%, 58.3%, and 70%, respectively] were inferior to EUS-FNA. Significant dfferences between post ERCP-C and post-EUS-FNA pancreatitis were detected [P<0.001]. EUS-FNA is more sensitive and safer for cytopathological diagnosis of pancreatic duct stricture than ERCP-C