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.