Grading epithelial atypia in endoscopic ultrasound‐guided fine‐needle aspiration of intraductal papillary mucinous neoplasms: An international interobserver concordance study

Impact of next-generation sequencing on the clinical diagnosis of pancreatic cysts

“…These findings support the value of NGS, given that the preoperative diagnosis of pancreatic cysts can be quite challenging, especially in centers without significant experience. 18,[43][44][45][46] Biochemical and cytologic analysis are valuable ancillary tests of pancreatic cyst fluid; however, appropriate specimen handling (eg, maintaining the cyst fluid fresh without dilution) and routine triage of cyst fluid for biochemical analysis is not always performed. In addition, CEA levels are not always elevated in mucinous cysts as shown in a significant number of the mucinous cysts in this study, and various cut points in CEA level supportive of a mucinous cyst affect accuracy.…”

“…The following exons were covered: AKT1 (3), ALK (22,23,25), APC (16), BRAF (11, 15), CDH1 (1, 2, 3, 4, 5, 6,7,8,9,10,11,12,13,14,15,16), CDKN2A (1, 2, 3), CTNNB1 (3), DDR2 (12,13,14,15,16,17,18), EGFR (7,15,18,19,20,21), ERBB2 (10, 20), ESR1 (8), FBXW7 (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11), FGFR1 (4,8,15,17), FGFR2 (7,9,12,14), FGFR3 (7,8,9,14,16), FOXL2 (1), GNA11 (5), GNAQ (4, 5), GNAS (6,7,8,9), HRAS (2, 3), IDH1 (3, 4), IDH2 (4), KIT (8,9,11,17), …”

“…A 2-tiered system has been proposed to distinguish cysts with low-grade epithelial atypia (low-intermediate grade dysplasia) that can be managed conservatively from cysts with high-grade atypia (HGA) (high-grade dysplasia or invasive carcinoma) that should be managed surgically. 18,19 With this approach, the finding of HGA has a specificity of 85% and a sensitivity of 72% for the detection of malignancy. 16 However, the criteria for high-grade cytology in mucinous cysts have been described only recently, 19 and accuracy requires experience and expertise.…”

Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines

“…Less than overt malignancy is best interpreted as either low-grade or high-grade atypia as the accuracy in distinguishing intermediate (moderate) from high-grade dysplasia is difficult if not impossible and the criteria to do so with any accuracy have not been established. [45] GI contaminating epithelium needs to be recognized as such (see criteria under Category I). Cytological criteria distinguishing high-grade atypia from low-grade atypia has recently been described.…”

“…[12] Cells smaller than a 12 μ duodenal enterocyte showing an increased nuclear to cytoplasmic ratio, an abnormal chromatin pattern and background necrosis represent high-grade epithelial atypia placing the cyst at high-risk for malignancy. [213464748]…”