A prospective comparison of conventional cytology and digital image analysis for the identification of pancreatic malignancy in patients undergoing EUS-FNA

BACKGROUND AND OBJECTIVES: Digital image analysis (DIA) has been reported to be a sensitive method to detect pancreatic neoplasms by assessing nuclear DNA content. The aim of the current study was to evaluate the diagnostic performance of DIA for pancreatic malignancy relative to conventional cytology (CC) in patients undergoing EUS-FNA. PATIENTS AND METHODS: One hundred and forty-two patients with suspected pancreatic malignancy were enrolled prospectively in this study. FNA sample from each patient was evenly divided and assessed by CC and DIA. Findings from histopathology of FNA specimens and a minimum 12-month follow-up were used as the standard. RESULTS: Total 102 out of 142 patients were determined as pancreatic cancer (PC) in this study. The overall sensitivity, specificity, and accuracy of CC were 75%, 85%, and 78%, whereas the sensitivity, specificity, and accuracy of DIA were 84%, 80%, and 83%, respectively. A combination of CC and DIA (CC/DIA) showed greater sensitivity than CC alone (92% vs. 75%, P < 0.01), but the specificity was reduced from 85% to 70% (P = 0.03). CONCLUSIONS: In this study, we demonstrated that DIA provided comparable diagnostic performance to CC in detecting PC. This objective diagnostic method, DIA, emerged as an important supplementary tool to endoscopic biopsy and cytology for diagnosing patients undergoing EUS-FNA with suspected pancreatic malignancy.