title: Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Differential diagnosis of malignant and benign intraductal papillary mucinous neoplasms (IPMNs) is essential to determine the optimal treatment. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently used to diagnose pancreatic cystic lesions worldwide, but few studies have focused on the diagnostic yield to distinguish malignant and benign IPMNs. Therefore, we aim to systematically review the diagnostic yield of EUS-FNA-based cytology to distinguish malignant and benign IPMNs.
  
  
  METHODS
  Relevant studies with a reference standard of definitive surgical histology which published between 2002 and 2012 were identified via MEDLINE and SCOPUS. Malignant IPMNs included invasive adenocarcinoma, carcinoma in situ, and high-grade dysplasia.
  
  
  RESULTS
  Four studies with 96 patients were included in this meta-analysis. For diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs, the pooled sensitivity and specificity were 64.8% (95% CI, 0.44-0.82) and 90.6% (95% CI, 0.81-0.96), respectively. Similarly, the positive likelihood ratio and negative likelihood ratio were 6.35 (95% CI, 2.95-13.68) and 0.43 (95% CI, 0.14-1.34), respectively. Malignant IPMNs were observed in 20.8% (20/96) of patients in EUS-FNA studies.
  
  
  CONCLUSIONS
  EUS-FNA-based cytology has good specificity but poor sensitivity in differentiating benign from malignant IPMNs. Newer techniques or markers are needed to improve diagnostic yield.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, United States.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Annangi
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, TX, United States.
authors.forename: Sushovan
authors.initials: S
authors.lastname: Guha
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: manoop.bhutani@mdanderson.org.
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D016013:Likelihood Functions; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity
keywords: Cytology; Endoscopic ultrasound-guided fine-needle aspiration; Intraductal papillary mucinous neoplasm; Malignancy; Meta-analysis; Pancreatic cystic lesion