Diagnostic features of low- and high-grade mucinous neoplasms in pancreatic cyst FNA cytology Journal Article
| Authors: | Sigel, C.; Wei, X. J.; Agaram, N.; Sigel, K.; Raza, R.; Andrade, R.; Rao, R.; Shah, P.; Soares, K.; Goyal, A. |
| Article Title: | Diagnostic features of low- and high-grade mucinous neoplasms in pancreatic cyst FNA cytology |
| Abstract: | Background: Pancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low- and high-grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison. Methods: Histologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low- and high-grade MN. A test for greater than or equal to four of eight high-grade features (three-dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high-grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high-risk clinical features are described. Results: Endoscopic ultrasound fine-needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low-grade = 69, 62%; high-grade = 24, 21%; and invasive = 19, 17%) and mucinous cystic neoplasms (low-grade = 20, 90%; high-grade = 2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid-like (40% vs. 6%, p <.01), covered >20% of the smear area (32% vs. none, p <.01), and contained histiocytes (46% vs. 18%, p =.04). Greater than or equal to four of eight select high-grade features was present in 36% of high-grade MN with sensitivity 37% and 98% specificity. Conclusion: Colloid-like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high-grade features had low sensitivity and high specificity for high-grade MN. © 2023 American Cancer Society. |
| Keywords: | pancreatic neoplasms; pancreas; cytology; pancreas cyst; cyst fluid; pathology; biopsy, fine-needle; pancreas tumor; mucin; mucins; intraductal papillary mucinous neoplasm; mucinous cystic neoplasm; pancreatic cyst; grading; fine needle aspiration biopsy; neoplasms, cystic, mucinous, and serous; humans; human; serous cystadenoma; psc classification; cystic, mucinous, and serous neoplasms |
| Journal Title: | Cancer Cytopathology |
| Volume: | 131 |
| Issue: | 5 |
| ISSN: | 1934-662X |
| Publisher: | John Wiley & Sons |
| Date Published: | 2023-05-01 |
| Start Page: | 325 |
| End Page: | 336 |
| Language: | English |
| DOI: | 10.1002/cncy.22681 |
| PUBMED: | 36650420 |
| PROVIDER: | scopus |
| PMCID: | PMC10593125 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Carlie Sigel -- Source: Scopus |
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