Cell Block Cellularity Correlation with Clinico-Pathologic Variables in Pancreatic Neoplasms
Sarah Navina, Alyssa M Krasinskas. University of Pittsburgh Medical Center, Pittsburgh, PA
Background: Diagnosis of pancreatic tumors relies heavily on EUS guided FNA diagnosis. Thus far, procuring sufficient material for diagnosis has been prioritized, and thus, adequacy assessment mainly addresses material for diagnosis, with collection of cell block material mainly for potential immunohistochemistry for diagnosis purposes. With the advent of effective neo-adjuvant therapy for some cancers, and the growing field of personalized medicine, emphasis needs to shift to obtaining adequate material in the pre-operative setting. This study aims to correlate cellularity of cell block material with several clinicopathologic variables in an attempt to ascertain optimal conditions for adequate material for pre-treatment or theranostic testing.
Design: Cytology cases of pancreatic neoplasms diagnosed at 2 hospitals (H1,H2) within our institution, that had cell blocks prepared were identified over a 6 month period. Only cases with a diagnosis of neoplasm/ malignancy were included, excluding all cases with an indeterminate diagnosis. Most EUS-FNAs used 25 gauge needles, some used 22 or 19 gauge needles. Cell block cellularity (CBC) was re-evaluated by a single cytopathologist and graded (scale of 1 to 4). Clinicopathologic variables included location, EUS-FNA operator, number of passes, EUS size of mass and on-site evaluation.
Results: There were a total of 90 cases -72 adenocarcinoma, 15 neuroendocrine tumors and 9 others at H1 and H2.
Overall CBC was significantly higher at H1 (p = 0.0123).
CBC was significantly associated with onsite adequacy evaluation (p =0.037).
CBC varied significantly between operators.
Mass size did not significantly affect CBC, when size cutoffs of 1cm or 3cm were used.
Neither the total number of passes nor the needle gauge affected CBC.
Conclusions: When comparing CBC for pancreatic tumors against clinico-pathologic variables, mass size, total number of passes and needle gauge did not show significant differences. However, CBC varied significantly with presence of on-site evaluation, between two hospitals and between FNA operators demonstrating that a combination of technical variables (pathologist involvement/onsite evaluation) and operator skill/experience and possibly other practice patterns between hospitals impacts CBC and in turn, adequacy for important ancillary/ theranostic tests.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 60, Tuesday Morning