Improved Detection of Mucinous Neoplasms in Pancreas: Cytology and Histology Correlation.
Carolina Reyes, Monica Garcia-Buitrago, Afonso Ribeiro, Parvin Ganjei-Azar. Jackson Memorial Hospital/University of Miami, Miami, FL; University of Miami/Sylvester Cancer Center, FL
Background: Pancreatic cystic neoplasms include intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystadenoma (SCA), and pseudocyst (PC). Diagnostic tools include endoscopic ultrasound fine needle aspiration (FNA) cytology and cyst fluid analysis. Surgery is recommended in cysts with abnormal cytology or lesions >3cm with fluid CEA levels >192ng/ml since these likely are mucinous neoplasms (MN). Nonmucinous neoplasms (nMN) are characterized by lower fluid CEA concentration. Our aim was to correlate the cytologic findings with the fluid CEA levels and the surgical diagnosis.
Design: FNA of pancreatic cystic lesions and pancreatic surgical specimens during a 6-year period were reviewed. Surgical specimens were classified as MN and nMN and subcharacterized as IPMN, MCN, SCA and PC. FNA specimens were assessed for presence of thick mucin, neoplastic epithelial/atypical cells, and macrophages. CEA fluid values were collected.
Results: Out of 628 FNA performed, a follow-up surgery was available in 47 cases. Of these, 40 were MN and 7 were nMN. Histologically, 28 were IPMN, 12 MCN, 5 SCA and 2 PC. In the IPMN, cytology showed thick mucin in most of the cases (64%), neoplastic epithelial cells in 36%, atypia in 21% and macrophages in 29%. Cytology of most MCN revealed macrophages (92%) and thick mucin or atypia (3.8%). In the SCA, cytology showed rare epithelial cells, mucin and atypia (9%). In the PC, cytology revealed thick mucin in 2 cases. All the cases had variable amount of contaminant gastrointestinal epithelium. Sensitivity and accuracy of cytology for diagnosis of MN was 60% and 57%, respectively. CEA fluid levels were found in 28 cases. The mean for MN was 11501ng/ml and for nMN was 36.8ng/ml. When adding CEA fluid level, sensitivity and accuracy for diagnosis of MN increased to 83% and 79%, respectively. There were 6/40 malignant MN. Of these 4 showed malignant cytology and 2 were nondiagnostic. Sensitivity and specificity for diagnosis of carcinoma was 67% and 94%, respectively. Only 2 of these cases had fluid CEA analysis (34.2 and 140ng/ml).
Conclusions: Identification of thick mucin is a helpful cytological feature for diagnosis of MN, which should be distinguished from contaminant gastrointestinal mucus. The yield for diagnosing MN is poor but it is improved with the inclusion of CEA fluid level. Cytology detection rate for malignant MN is higher and fluid CEA level does not appear to increase the diagnostic yield.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 67, Tuesday Morning