Fine Needle Aspiration Biopsy for Preoperative Workup of Pancreatic Cystic Neoplasms

Delatour, Nicolas Roustan; Policarpio‐Nicolas, Maria Luisa; Yazdi, Hossein M.; Islam, Shahidul

doi:10.1159/000325872

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…It is now widely recognized that the findings of cytology should be interpreted in the context of the radiologic and laboratory findings, to avoid misdiagnosis. [ 16 - 19 ] For example, many branch duct IPMNs have a lining that is indistinguishable from that of normal gastric epithelium, so gastric contamination cannot always be excluded from cytology. [ 20 , 21 ] The characteristic ovarian-type stroma of mucinous cystic neoplasms is usually not apparent in FNA samples, and these entities can be cytologically indistinguishable from IPMNs.…”

Section: Discussionmentioning

confidence: 99%

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

Serinelli,

Khurana

2024

Cytojournal

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Objective: Intraductal papillary mucinous neoplasms (IPMNs) may be associated with invasive adenocarcinoma, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). We aimed to review the cytologic-histologic correlation of cases with a histologic diagnosis of IPMN. Material and Methods: A database search (January 2010–January 2021) was performed for resected IPMNs with preceding endoscopic ultrasound-guided fine-needle aspiration (FNA). Cytology slides were reviewed for the presence of benign, atypical, or malignant cells, and necrosis. Histologically, IPMNs were classified as benign (LGD) or malignant (HGD or adenocarcinoma). Results: There were 41 patients with IPMN; 24 malignant and 17 benign. Sixteen of the 24 malignant IPMNs were accurately classified as malignant on cytology. There were eight false negatives and one false positive. Cytology yielded a sensitivity of 67% and a specificity of 94%. Among the 16 true positives with FNA diagnosis of adenocarcinoma, seven were IPMNs with HGD, and nine had invasive adenocarcinomas on histology. Cellular morphology and absence or presence of necrosis did not help distinguish HGD from adenocarcinoma on cytology (P > 0.5). Sampling errors and interpretative errors resulted in false-negative cases. Cytology yielded diagnoses related to IPMN in 73% of cases (30/41) and lack of identification of mucinous cells/mucinous background resulted in interpretative errors (9). Conclusion: This study shows that there is a good correlation between cytopathology and surgical pathology diagnoses of IPMNs and that cytology is mostly able to recognize IPMN with HGD/adenocarcinoma. However, heterogeneity in areas of IPMN with HGD/adenocarcinoma may result in sampling errors yielding false-negative cases. Mucinous cells/background should raise the suspicion of IPMN on cytology, even when no neoplastic epithelium is present for the evaluation of dysplasia.

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Section: Discussionmentioning

confidence: 99%

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

Serinelli,

Khurana

2024

Cytojournal

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“…This did not include reports of the use of FNA for the diagnosis that lack a description of the cytomorphologic features of the case(s). These reports are collected, reviewed and compared with the current findings [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. …”

Section: Methodsmentioning

confidence: 99%

Serous Cystadenoma of the Pancreas with Endoscopic Ultrasound Fine Needle Aspiration Biopsy and Surgical Correlation

Collins

2013

Acta Cytologica

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Objectives: Endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsies are commonly used to diagnose tumors of the pancreas. Serous cystadenoma (SCA) is a benign neoplasm that is uncommon and accounts for 1-2% of all pancreatic neoplasms. Study Design: Surgically excised SCAs with preoperative EUS FNA biopsy over a 10-year span were identified. Clinical data were collected, and cytomorphologic features reviewed retrospectively and correlated with surgical excision data. Original cytopathologic diagnoses and retrospectively reviewed cytomorphology features were recorded. Results: Seventeen patients were identified. Original EUS FNA interpretation included 1 ‘unsatisfactory', 9 ‘negative for malignancy' and 7 ‘atypical' or greater; however, all cases were categorized as benign/negative or nondiagnostic on retrospective review. The cases were hypocellular and possessed variable (rare to few-moderate) groups of bland cuboidal epithelial cells embedded in granular debris. Mucosal sampling was present (7/17) and cell blocks were acellular (5/17). Conclusion: This is a large series of pancreas SCAs subjected exclusively to EUS FNA biopsy where all cases had surgical excision confirmation. The 17 cases had hypocellular aspirate smears with the majority showing few bland epithelial cells; however, this can limit definitive diagnosis based on the cytomorphologic evaluation alone. The aspirate smear pattern of EUS FNA of SCAs of the pancreas supports a benign/negative or nondiagnostic categorization.

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Fine‐needle aspiration of cystic pancreatic mucinous tumor: Oncotic cell as an aiding diagnostic feature in paucicellular specimens

Xiao

2008

Diagnostic Cytopathology

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In juxtaposition with imaging studies, endoscopic ultrasound-guided fine-needle aspiration has gained popularity in the initial evaluation of pancreatic masses, especially cystic lesions of pancreas. Cystic pancreatic mucinous tumors include mucinous cystic neoplasm and intraductal papillary mucinous tumor, both of which have been known to have a low malignant potential and a high rate of association with invasive adenocarcinoma. As such, preoperative diagnosis is of great significance in guiding patient management. Although fine-needle aspiration cytological diagnosis of pancreatic tumor in cellular specimens has been well described, as with other cystic lesions, the yield of diagnostic cells from needle aspiration of cystic pancreatic mucinous tumors is typically low. Cytological diagnosis from these paucicellular specimens remains challenging. An additional compounding problem is the high frequency of gastrointestinal mucin and epithelial contamination. The diagnostic morphology and criteria in these paucicellular specimens have not been well addressed in the literature. The cytopathologists' ongoing efforts tend to improve the diagnostic accuracy. In this current study, oncotic cells, characterized by cytoplasmic swelling and karyolysis, were analyzed from 17 cases of cystic pancreatic mucinous tumor, of which the diagnosis was either confirmed by surgical resection or supported by cell block and/or increased CEA. Oncotic cells were found in variable amounts in almost all the cystic pancreatic mucinous tumors in this series. None of the five fine-needle aspirations intended for aspirations of hypoechoic nonlesional pancreas, which yielded either gastrointestinal tract material only or admixture of gastrointestinal and normal pancreatic components, was found to contain oncotic cells, evidencing the utility of oncotic cell as a surrogate morphologic marker in aiding the diagnosis of cystic pancreatic mucinous tumor as well as its differentiation from gastrointestinal contaminant, particularly in paucicellular specimens.

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Fine Needle Aspiration Biopsy for Preoperative Workup of Pancreatic Cystic Neoplasms

Cited by 7 publications

References 23 publications

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

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

Serous Cystadenoma of the Pancreas with Endoscopic Ultrasound Fine Needle Aspiration Biopsy and Surgical Correlation

Fine‐needle aspiration of cystic pancreatic mucinous tumor: Oncotic cell as an aiding diagnostic feature in paucicellular specimens

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