Ultrasound-guided fine-needle aspiration cytology for pancreatic neoplasms: diagnostic accuracy and effects on clinical decision-making

Abstract Objectives This study aimed to evaluate the efficacy and safety of ultrasound-guided percutaneous fine-needle aspiration (US-FNA) in diagnosing pancreatic neoplasms and to determine its potential effects on clinical decision-making. Methods We retrospectively analysed the clinical data of 133 patients with pancreatic neoplasms who underwent US-FNA from January 2018–July 2023. The cytological results were classified based on the six-level reporting system recommended by the American Society of Cytopathology. The diagnostic criteria of the pancreatic aspiration cytology were determined based on biopsy, imaging, and clinical follow-up results and were as follows: (1) malignant cytology, after clinical and/or imaging follow-up, tumour progression or patient death could be diagnosed as pancreatic cancer and (2) benign cytology, no lesion progression after 6 months of follow-up. The effects of US-FNA on clinical decision-making were evaluated by univariate and multivariate analyses of factors affecting diagnostic accuracy. Results The results of US-FNA cytology were classified as follows: grade Ⅰ, inadequate (n = 6, 4.5%); grade Ⅱ, benign (n = 12, 9.0%); grade Ⅲ, atypical (n = 18, 13.5%); grade IV, neoplastic lesions (n = 0); grade V, suspected malignancy (n = 35, 26.3%), and grade VI malignancy (n = 62, 46.6%); the satisfaction rate of the samples was 95.5%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-FNA in differentiating benign and malignant lesions were 91.3%, 100%, 100%, 8.3%, and 91.3%, respectively. Univariate analysis indicated significant differences in experience of puncture physicians between the correct and wrong diagnosis groups(P < 0.05),which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis(p = 0.04,OR = 3.959,95%CI:1.022–14.92). Most of the patients tolerated FNA, some experienced mild abdominal pain during or after biopsy, and two cases presented with minor peripancreatic haemorrhage, with a complication rate of 1.5%. The treatment strategy for 116 (87.2%) patients was affected by the US-FNA results. Conclusion US-FNA-based diagnosis has high sensitivity, specificity, and accuracy, which indicate its high diagnostic value for pancreatic neoplasms. The low incidence of complications suggests that the safety of US-FNA cytology is high. Therefore, US-FNA holds high potential to be used in routine diagnosis and clinical decision-making for pancreatic neoplasms.