Assessment of Pancreatic Neoplasms: Review of Biopsy Techniques

Goldin, Steven B.; Bradner, Michael W.; Zervos, Emmanuel E.; Rosemurgy, Alexander S.

doi:10.1007/s11605-007-0114-2

Cited by 31 publications

(23 citation statements)

References 64 publications

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“…These tumors require a multimodal diagnostic approach, combining clinical history, radiological imaging studies, histopathology, immunohistochemistry, and ultrastructural studies. When a diagnosis can be made from a FNA specimen and can lead to a change in the management of the patient, a FNA should be included in this multimodal diagnostic approach 4. We report a case of a 66 year‐old man who underwent an ultrasound‐guided fine‐needle‐aspiration and core biopsy of a liver lesion.…”

mentioning

confidence: 99%

Metastatic mixed acinar‐neuroendocrine carcinoma of the pancreas to the liver: A cytopathology case report with review of the literature

Lee

Bajor-Dattilo

Das

2011

Diagnostic Cytopathology

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A case of metastatic mixed acinar-neuroendocrine carcinoma (MANEC) of the pancreas to the liver is reported. A diagnostic percutaneous US-guided FNA and core biopsy of a liver nodule was performed. The FNA smears were cellular and showed neoplastic cells in clusters with acinar formation, isolated single cells, and scattered naked nuclei. The cytoplasm was finely granular. The nuclei were relatively uniform, some with speckled chromatin and prominent nucleoli. The immunohistochemistry performed on the cell block showed strong positivity for cytokeratin AE1/AE3, chromogranin, and synaptophysin. Furthermore, the tumor cells were weakly positive for α1-antichymotrypsin. The Ki-67 mitotic index was up to 50%. Based on the morphology and supporting immunohistochemical stains, the final cytopathologic diagnosis rendered was "Positive for malignant cells. Carcinoma with mixed acinar and endocrine features." To our knowledge, this is the first report of a metastatic MANEC to the liver diagnosed based on cytology with confirmatory histology. The difficulties in the cytopathologic diagnosis and differential diagnosis of MANEC are discussed in this article.

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mentioning

confidence: 99%

Metastatic mixed acinar‐neuroendocrine carcinoma of the pancreas to the liver: A cytopathology case report with review of the literature

Lee

Bajor-Dattilo

Das

2011

Diagnostic Cytopathology

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“…[2][3][4][5] The sensitivity of FNA has been shown to range from 45 to 100% (site dependent) with a specificity approaching 100% and diagnostic accuracy ranging from 60 to 95%. [2][3][4][6][7][8] However, there are limitations to EUS-guided FNA. Cytologic interpretation of FNA specimens can be difficult in specimens with obscuring blood, necrotic material, inflammatory cells, or from neoplasms requiring immunohistochemical (IHC) studies for definitive classification.…”

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confidence: 99%

Comparison of EUS‐guided FNA and Trucut biopsy for diagnosing and staging abdominal and mediastinal neoplasms

Kipp¹,

Pereira²,

Souza³

et al. 2009

Diagnostic Cytopathology

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The objective of this study was to evaluate endoscopic ultrasound Trucut biopsy (TCB) specimens and compare these findings to fine needle aspiration (FNA) specimens for the diagnosis of neoplasia. FNA and TCB specimens were reviewed in blinded fashion by a cytopathologist from patients (N = 93) who had EUS-guided FNA and TCB specimens collected between July 2000 and January 2005. Specimens were categorized as nondiagnostic, negative, suspicious for stromal neoplasm, suspicious for malignancy, positive for stromal neoplasm, or positive for malignancy. Standard final diagnosis based on clinical and/or pathologic follow-up was available for 86 of 93 patients. The final diagnoses comprised malignancy (n = 55), stromal neoplasm (n = 19), and benign findings (n = 12). The combination of FNA and TCB results combined were significantly (P < 0.001) more sensitive that FNA alone for the detection of both malignancy (78% vs. 55%) and stromal neoplasia (79% vs. 19%) without a significant change in overall specificity (92% vs. 100%, P = 1.00). A positive FNA specimen with a negative/nondiagnostic TCB result was established in seven patients with malignancy. A positive TCB diagnosis with a negative/nondiagnostic FNA result was noted in five patients with malignancy. A suspicious FNA result was upgraded to positive in conjunction with TCB specimen evaluation in eight patients with malignancy. The results of this study suggest that TCB is a useful adjunctive technique when used in tandem with FNA for malignancy and stromal neoplasia detection. Additional data are needed to firmly establish practice guidelines for the use of EUS-guided TCB specimens in clinical practice.

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“…Pathological confirmation. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and percutaneous core needle biopsy are two common methods for obtaining tissue samples in p-NENs (17).…”

Section: Results and Consensus Statementsmentioning

confidence: 99%

“…In comparison, percutaneous core needle biopsy has relatively greater availability, lower cost, a higher success rate, enables access to sufficient material and allows access to lesions in any part of the pancreas (17,(25)(26)(27). Sufficient material can be extracted to determine cell type and origin via histologic and immunohistochemical analyses, thus, allowing for reliable differentiation of p-NENs (28).…”

Section: Results and Consensus Statementsmentioning

confidence: 99%

Surgical management for non-functional pancreatic neuroendocrine neoplasms with synchronous liver metastasis: A consensus from the Chinese Study Group for Neuroendocrine Tumors (CSNET)

Jin¹,

Xu²,

Chen³

et al. 2016

International Journal of Oncology

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Pancreatic neuroendocrine neoplasms (p-NENs) are slowly growing tumors with frequent liver metastasis. There is a variety of approaches to treat non-functional p-NENs with synchronous liver metastasis (LM) which complicates the determination of optimal treatment. Based on updated literature review, we discussed the treatment strategy determinants for p-NEN with LM. According to the resectability of primary tumor, the WHO 2010 grade classification and the radiological type of liver metastasis, the CSNET group reached agreements on a number of issues, including the following. Prior to treatment, biopsy is required to confirm pathology. Liver biopsy is important for more accurate grading of tumor and percutaneous core needle biopsy is more available than EUS-FNA. In patients with unresectable primary, surgical resection for liver-metastatic lesions should be avoided. Curative surgery is recommended for G1/G2 p-NET with type I LM and R1 resection also seems to improve overall survival rate. Cytoreductive surgery is recommended for G1/G2 p-NET with type II LM in select patients, and should meet stated requirements. Surgical resection for G1/G2 p-NET with type III LM and p-NEC with LM should be avoided, and insufficient evidence exists to guide the surgical treatment of G3 p-NET with LM. Liver transplantation may be an option in highly select patients. In addition, the optimal time for surgical approach is still required for more evidence.

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Assessment of Pancreatic Neoplasms: Review of Biopsy Techniques

Cited by 31 publications

References 64 publications

Metastatic mixed acinar‐neuroendocrine carcinoma of the pancreas to the liver: A cytopathology case report with review of the literature

Metastatic mixed acinar‐neuroendocrine carcinoma of the pancreas to the liver: A cytopathology case report with review of the literature

Comparison of EUS‐guided FNA and Trucut biopsy for diagnosing and staging abdominal and mediastinal neoplasms

Surgical management for non-functional pancreatic neuroendocrine neoplasms with synchronous liver metastasis: A consensus from the Chinese Study Group for Neuroendocrine Tumors (CSNET)

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