title: The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249-6823, USA. shebertm@uab.edu
authors.forename: S
authors.initials: S
authors.lastname: Hébert-Magee
authors.forename: S
authors.initials: S
authors.lastname: Bae
authors.forename: S
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: J
authors.initials: J
authors.lastname: Ramesh
authors.forename: A R
authors.initials: AR
authors.lastname: Frost
authors.forename: M A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: I A
authors.initials: IA
authors.lastname: Eltoum
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D003581:Cytodiagnosis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D019160:Endosonography; D006801:Humans; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity