Molecular-Cytologic Correlation of Pancreatic Cystic Lesions (PCL): Our Experience
PA Rodriguez Urrego, MK Kim, D Sejpal, B Schainker, H Chen, M Wu. Mount Sinai Medical School, NY, NY
Background: Recently molecular analysis (MDX) of pancreatic cyst fluid has been included in the armamentarium of ancillary tests to assess the multidisciplinary preoperative diagnosis of PCL. Few studies show correlation among these diagnostic tools. The purpose of the study is to present our experience.
Design: MDX PathFinderTG® (RedPath Integrated Pathology, Pittsburgh, PA) reports corresponding to PCLs received in the past 11 months were retrospectively reviewed. Comparison with cytologic diagnosis (CDX), CEA fluid level (> 192 ng/ml P positive, <192 ng/ml N negative, NA not available) and surgical diagnosis (SDX) was performed. Cases were divided in 4 categories including, benign non mucinous neoplasms (BNM), mucinous neoplasms (MN), malignant and non-diagnostic (ND).
Results: A total of 27 PCL including 17 females and 10 males, within 32 to 83 years of age were analyzed. PCLs were located in the head (12), body (9) and tail (5). 26 PCLs had concurrent CDX and only 4 cases had SDX (table1).
1. PCL correlationSSPT solid pseudopapillary tumor, MCA mucinous cystadenoma, IPMN intraductal papillary mucinous neoplasm
Among those, 2 correlated and the other 2 were incorrectly classified, one by each technique. CEA fluid level was available in 3 cases, 2 were concordant and 1 was not. MDX detected 14 BNM, 10 MN and 2 ND cases (table 2).
2. Correlation: MDX Vs. CDXC corelate, NC non correlate
No malignant diagnosis was rendered. CDX & MDX correlation was better for BNM (64%) than MN (30%). MN had a more ND cases on CDX . All the ND-CDX were reviewed. Four cases had scant slightlly atypical epithelium, favoring MN, 2 of them with positive concordant CEA. 2 cases had macrophages, compatible with BNM and 3 cases were virtually acellular (true ND). 2 cases had mucinous epithelium interpreted as gastrointestinal (GI) origin and 1 had acute inflammation.
Conclusions: Longer follow up is necessary to determine value of MDX. Greater proportion of MN is detected by MDX Vs CDX. Cytology is better at diagnosing BNM than MN, careful and descriptive examination may reduce the rate of ND CDX, especially in MN. Cytological interpretation is limited when evaluating benign mucinous epithelium: neoplastic Vs GI contaminants. Molecular and cytologic criteria need to be strictly defined to grant a better assessment of PCLs in future studies.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 39, Wednesday Afternoon