Cytologic Features and Diagnostic Yield of 330 Pancreatic Duct Aspirates.
Indu S Basil, Harvey M Cramer, Stuart Sherman, Robert E Emerson. Indiana University School of Medicine, Indianapolis
Background: Pancreatic duct aspiration cytology is routinely used as part of the evaluation of patients presenting with recurrent pancreatitis and is useful in the detection of pancreatic tumors involving the pancreatic ducts such as intraductal papillary mucinous neoplasm (IPMN).
Design: The pathology reports and clinical follow-up data for all available pancreatic duct aspirate cases for a 9½-year period were reviewed. The original cytologic diagnoses were grouped into the following diagnostic categories: unsatisfactory, negative for malignancy, extracellular mucin (without atypical cells), atypical cells suspicious for IPMN, IPMN, and adenocarcinoma. The presence of IPMN, pancreatic intraepithelial neoplasia, or adenocarcinoma was considered positive follow-up.
Results: There were 330 pancreatic duct aspirations. The mean patient age was 62.5 years (range: 25 to 87), 122 patients were men (37%), and 208 were women (63%). Specimen processing techniques included centrifugation and preparation of direct smears (231 cases), cytospin slides (2), Hettich preparations (18), ThinPrep processing (41), SurePath processing (37), and a combination of methods (1). Overall, 22 (7%) were considered unsatisfactory, 226 (68%) were negative, 25 (8%) contained extracellular mucin only, 29 (9%) were suspicious for IPMN, 10 (3%) were considered diagnostic of IPMN, 9 (3%) were atypical, and 9 (3%) were adenocarcinoma. Extracellular mucin only was reported for 17 direct smear (7%), 2 ThinPrep (5%), 3 SurePath (8%), and 3 Hettich (17%) cases. An abnormal diagnosis (either extracellular mucin, suspicious for IPMN, IPMN, atypical, or adenocarcinoma) was reported for 64 direct smear (28%), 6 ThinPrep (15%), 7 SurePath (19%), and 5 Hettich (28%) cases. Ninety cases (27%) had histologic follow-up: 73 were positive for neoplasm (81%) and 17 were negative (19%). There was 1 false positive (direct smear suspicious for IPMN, histologically only chronic pancreatitis). All 14 cases reported as extracellular mucin only had a neoplasm. If abundant thick extracellular mucin was also considered abnormal, the sensitivity was 58% for direct smears (33/57), 43% for ThinPrep (3/7), and 57% for SurePath (4/7).
Conclusions: An abnormal pancreatic duct aspirate cytology result is highly specific for neoplasia. The sensitivity of an abnormal cytologic diagnosis was 37%, but if abundant extracellular mucin was also considered an abnormal result the sensitivity improved to 56%.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 65, Tuesday Morning