Background features in the cytology of pancreatic neoplasms

Abstract

Cytology is a useful method for diagnosing pancreatic neoplasms. Although endoscopic ultrasound‐guided fine‐needle aspiration has recently become the mainstream method for the diagnosis of pancreatic neoplasms, pancreatic juice and pancreatic duct brushing cytology continue to be useful diagnostic methods for the investigation of pancreatic neoplasms. Diagnoses using pancreatic cytology are primarily based on the features related to tumor cells; however, evaluation of the background features provides important information that could further aid the diagnosis. Pancreatic neoplasms show various histological types, each of which is associated with its own characteristic background features. The necrotic background, desmoplastic stroma, and presence of cancer‐associated fibroblasts are background features of pancreatic ductal adenocarcinoma, a mucinous background is associated with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, and hyaline globules are observed in solid pseudopapillary neoplasms. However, some background features are associated with more than one histological type of pancreatic neoplasm, highlighting the importance to base a diagnosis on the results of a comprehensive analysis of not only the background features but also the tumor cells. Here, we provide a review of the key background cytological features of pancreatic neoplasms, which can serve as a guide to improve diagnosis and research.

Sensitivity of endoscopic ultrasound‐guided fine‐needle aspiration cytology and biopsy for a diagnosis of pancreatic ductal adenocarcinoma: A comparative analysis

“…That is, we identified cases in which the mass had been classified into Category B on the basis of EUS-FNAC but into Category C/D on the basis of EUS-FNAB and vice versa. We then evaluated cytologic features as: background (clear vs. necrotic background) ('clear background' was defined as viable cells with an absence of necrotic tissue; 'necrotic background' was defined as diffuse necrosis complicated with various numbers of conspicuous malignant cells); 15,16 quantity of atypical cells in the sample (few vs. numerous); characteristics of the nuclei, that is, arrangement (regular vs. irregular), atypia (mild, severe (with severe nuclear atypia manifested as anisonucleosis or irregularly shaped nuclei, or uneven distribution of coarse chromatin)); and the nuclear/cytoplasmic (N/C) ratio (<60%, ≥60%). Further, we examined the following histomorphologic features of these masses: background (clear, necrotic), quantity of atypical cells in the sample (few, numerous), atypical glandular structures (few <3, numerous ≥3) cytologic atypia (mild, severe), and atypical cells that appear degenerate or necrotic (few, numerous).…”

Advances in the Early Diagnosis of Pancreatic Ductal Adenocarcinoma and Premalignant Pancreatic Lesions

“…The imaging features of PDAC at different stag summarized in Figure 1. In addition to diagnosing pancreatic cancer via the cytology/pathology of FNA/FNB specimens, the cytological analysis of the pancreatic juice obtained via can be used to help diagnose pancreatic malignancies [24]. The background cytolog pathological features of pancreatic neoplasms can also be helpful for distingu different types of pancreatic lesions.…”

“…The background cytolog pathological features of pancreatic neoplasms can also be helpful for distingu different types of pancreatic lesions. For example, desmoplastic stroma and the pre In addition to diagnosing pancreatic cancer via the cytology/pathology of EUS-FNA/FNB specimens, the cytological analysis of the pancreatic juice obtained via ERCP can be used to help diagnose pancreatic malignancies [24]. The background cytological or pathological features of pancreatic neoplasms can also be helpful for distinguishing different types of pancreatic lesions.…”

Intraductal papillary mucinous neoplasms of the pancreas: Cytologic-histologic correlation study and evaluation of the cytologic accuracy in identifying high-grade dysplasia/invasive adenocarcinoma

“…Preoperative diagnosis of IPMN is currently based on radiologic studies, [ 8 ] pancreatic duct brushings/fine-needle aspiration (FNA) biopsy, [ 9 - 11 ] and carcinoembryonic antigen (CEA) level, which is usually elevated. More recently, molecular/genetic/genomic studies have become critical for the diagnosis.…”