Pancreatic Adenocarcinoma: Diagnosis by Ultrasound-Guided Fine-Needle Aspiration-Cyto-Histological Correlation and Experience at a Multidisciplinary Tertiary Reference Center.

[BACKGROUND] Pancreatic adenocarcinoma (PDAC) is characterized by its poor prognosis. Cytology is essential for diagnostic confirmation and ancillary studies. The endoscopic ultrasound (EUS) set a precedent, facilitating cytological sampling through fine-needle aspiration (FNA), with a sensitivity of 93% and a specificity of 95%. In this work, we analyzed all EUS-guided pancreatic FNAs performed at our center over 2014-2025 and compared the cytological findings with the corresponding surgical specimen results.

[METHODS] Observational, descriptive, and retrospective study of all EUS-guided pancreatic FNAs performed at our center (2014-January 2025) in patients ≥ 18 years and their corresponding surgical specimens. Samples were obtained using a linear echoendoscope and 25G needles, processed with Romanowsky and Papanicolaou stains, and cell blocks prepared for immunohistochemistry. Cytological diagnoses followed WHO criteria; histology from surgical specimens served as the reference standard. Statistical analysis was performed using SPSS v.22 with p < 0.05 considered significant.

[RESULTS] One hundred and sixty-three EUS-guided pancreatic FNAs were performed and 34 patients underwent surgical treatment (20.8%), 31 of them (91.2%) with a cytological diagnosis of malignancy. Thirty-three patients had malignant lesions (97%) in the surgical specimen. Cytology showed a sensitivity of 96.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. Cyto-histological correlation was 91.2% with a κ = 0.654 (p < 0.001). Cytopathologists' expertise was statistically significant (p < 0.001).

[CONCLUSIONS] Cytology is highly reliable for confirming malignancy. Final management will be multidisciplinary.