Background and aims:Introduction:Early detection and accurate pathological assessment are critical to improving prognosis of pancreatic cancer.EUS has been widely used in diagnosing pancreatic lesions and can obtain histological diagnosis by EUS-FNA.However,comprehensive assessment of the interobserver agreement (IOA) among cytopathologists evaluating EUS-FNA specimens is still limited.Therefore,this study evaluated IOA among cytopathologists for EUS-FNA specimens of solid pancreatic lesions especially in false-negative cases of cytological diagnosis and analysed the factors that influence cytological diagnosis of EUS-FNA,so as to improve the diagnostic efficiency of EUS-FNA. Methods:We retrieved EUS-FNA samples of pancreatic solid lesions from 2017 to 2021 and collected their clinical/cytological datas.Two cytopathologists independently reviewed these cases using a quoted,novel standardized cytology scoring tool.Ultimately,we calculated IOA among cytopathologists and performed a binary logtistic regression analysis to evaluate factors influencing the cytological diagnosis of EUS-FNA. Results:161 patients were included and sixty cases with a clinical diagnosis of pancreatic cancer but a cytological diagnosis of benign and atypical constituted the false-negative group.IOA for cytologic diagnosis of overall patients and the false-negative group were perfect/moderate agreement with Kendall’s W value of 0.896 and 0.462 respectively.The number of diagnostic cells in the scoring tool had the highest level of agreement(κ=0.721) for overall patients.There was at best moderate agreement on other quantity and quality parameters for both all cases and false-negative gruop.Logistic regression analysis showed the number of diagnostic cells(OR=6.110,p<0.05) and amount of blood(OR=0.320,p<0.05) could influence cytological diagnosis. Conclusions:The false-negative rate of our study as high as 37.26%(60/161)is mainly related to strict standards of cytopathologist and their ability to standardise pancreatic cytology is still improving.Suboptimal agreement among cytopathologists for cytologic diagnosis and the number of diagnostic cells may be associated with the occurrence of false negative diagnosis.Further regression analysis confirmed that the number of diagnostic cells and obscuring blood were an important factors in cytological diagnosis.Therefore,refinement of cytological diagnostic criteria,standardization of specimen quality evaluation and training of cytopathologists may improve the agreement of cytopathologists,thus improving the repeatability of cytological diagnosis and reducing the occurrence of false-negative events.


中文翻译：

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细胞病理学家在使用 EUS-FNA 进行实体胰腺病变细胞学诊断的假阴性病例中观察者间的一致性

背景与目的：引言：早期发现和准确的病理评估对于改善胰腺癌的预后至关重要。EUS已广泛应用于诊断胰腺病变，通过EUS-FNA可以获得组织学诊断。然而，综合评估观察者间一致性（IOA）因此，本研究评估了细胞病理学家对胰腺实性病变EUS-FNA标本的IOA，特别是细胞学诊断假阴性病例的IOA，并分析了影响EUS-FNA细胞学诊断的因素，从而提高EUS-FNA的诊断效率。方法：我们检索了2017年至2021年胰腺实性病变的EUS-FNA样本，并收集了其临床/细胞学数据。两名细胞病理学家使用引用的新型标准化细胞学评分工具独立审查这些病例。最终，我们计算了细胞病理学家之间的IOA，并进行了二元logistic回归分析评估影响EUS-FNA细胞学诊断的因素。结果：纳入161例患者，其中60例临床诊断为胰腺癌，但细胞学诊断为良性和不典型的患者构成假阴性组。总体患者细胞学诊断IOA与假阴性组完全/中等符合Kendall 的 W 值分别为 0.896 和 0.462。评分工具中的诊断细胞数量对于整体患者具有最高程度的一致性（κ=0.721）。所有病例和患者的其他数量和质量参数至多具有中等程度的一致性。 Logistic回归分析显示诊断细胞数(OR=6.110,p<0.05)和血液量(OR=0.320,p<0.05)可影响细胞学诊断。结论：本研究假阴性率高达37.26%（60/161），主要与细胞病理学家的严格标准有关，他们规范胰腺细胞学的能力仍在提高。诊断细胞数量可能与假阴性诊断的发生有关。进一步回归分析证实，诊断细胞数量和血液模糊是影响细胞学诊断的重要因素。因此，细化细胞学诊断标准、标准化标本质量评价和培训细胞病理学家可以提高细胞病理学家的一致性，从而提高细胞学诊断的可重复性，减少假阴性事件的发生。