Molecular Analysis of Pancreatic Cyst Fluid: Correlation with Cytologic Diagnosis and Surgical Follow-Up
G Cai, U Siddiqui, H Aslanian, A Finkelstein, K Schofield, D Chhieng. Yale University School of Medicine, New Haven, CT
Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is increasingly utilized as a preferential tool for the work-up of pancreatic cystic lesion. Clinical management of these cystic lesions is largely dependent on revelation of the nature of cystic lesions. It is however quite challenging to render a diagnosis based on cytomorphologic analysis alone. Few previous studies have demonstrated that ancillary studies such as fluid amylase and CEA levels as well as molecular approaches play an important role in classifying and diagnosing pancreatic cystic lesions. In this study, we retrospectively review our experience with molecular analysis of pancreatic fluid and its correlation with cytologic diagnosis and surgical follow-up.
Design: A total of 82 pancreatic cyst EUS-FNA specimens from 71 patients that had concurrent molecular analysis were retrieved from the cytopathology archives at our institution. RedPath Integrated Pathology performed molecular analysis as a commercially available test. Molecular analysis, based on DNA quality/quantity, K-ras mutation and allelic imbalance mutation, classified cystic lesions into benign serous neoplasm, low, intermediate, and high grade mucinous cystic neoplasm (MCN). Surgical follow-up was available in 20 patients (28%).
Results: Of 82 cases, 20, 4, 37, 21 cases were classified as MCN, adenocarcinoma, bland epithelial cells and cyst content by cytomorphologic analysis. By molecular analysis, 23 cases of cytologically MCN and adenocarcinoma were classified as low, intermediate, and high grade MCN. Eighteen and 11 cases cytologically diagnosed diagnosed as bland epithelial cells were classified as MCN and serous neoplasm, respectively. For cyst content only cases, 13 cases were classified as either MCN or serous neoplasm. Classification render by molecular analysis had a 95% correlation rate with surgical follow up in classification.
Conclusions: Molecular analysis of pancreatic cyst fluid played a significant role in the diagnosis and classification of pancreatic cystic lesions in addition to cytmorphologic analysis.
Tuesday, March 23, 2010 8:15 AM
Platform Session: Section F, Tuesday Morning