Ercp cytology and eus-fna cytology in the diagnosis of malignant distal biliary and pancreatic suct strictures

Abstract EN

Background: Endoscopic retrograde cholangiopancreatography (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 ofpancreatic 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 methods: A prospective study included 56 patients with pancreatic duct stricture was performed.

ERCP-C and EUS-FNA were carried out for cytopathological diagnosis.

Results: 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, NPV, 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 differences between post ERCP-C and post-EUS-FNA pancreatitis were detected (P < 0.001).

Conclusions: EUS-FNA is more sensitive and safer for cytopathological diagnosis ofpancreatic duct stricture than ERCP-C.