Cytomorphology, Cyst Fluid Analysis and Molecular Tests in Pancreatic Cystic Lesions: Review of 459 Cases
Berrin Ustun, Ahmed Alomari, Gillian H Levy, David Chhieng, Harry R Aslanian, Uzma Siddiqui, Guoping Cai. Yale University School of Medicine, New Haven, CT
Background: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is increasingly used to evaluate cystic lesions of the pancreas. It is however quite difficult to accurately diagnose these lesions due to scant cellularity and subtle cytomorphologic features. Cyst fluid analysis and molecular tests may help improve diagnostic performance. In this study, we retrospectively reviewed our experience with cystic pancreatic lesions diagnosed by EUS-FNA.
Design: The electronic data of cytopathology archives were searched for pancreatic lesions diagnosed by EUS-FNA at our institution during the period from January 2005 to June 2011. A total of 1,143 cases were retrieved, of which 459 cases (40%) were cystic lesions. The cytomorphologic diagnoses and the results of cyst fluid analysis (amylase and CEA levels) and molecular tests (K-ras mutation, loss of heterozygosity [LOH] of tumor suppressor gene alleles) were reviewed. Histopathologic follow-up was available for comparison in 81 cases.
Results: The cytomorphologic diagnoses included non-diagnostic (48 cases, 10%), negative (127 cases, 28%), bland/cyst contents (160 cases, 35%), atypical (26 cases, 6%), pancreatic endocrine neoplasm (6 cases, 1%), mucinous cystic neoplasm (84 cases, 18%), and malignant (8 cases, 2%). Elevated CEA level (>=192 ng/ml), positive K-ras mutation and LOH were found in 25 of 79 (32%), 49 of 137 (36%), and 54 of 94 (53%) cases, respectively. Histopathologic follow-up was compared with cytomorphologic diagnoses (Table 1) as well as the results of cyst fluid analysis, K-ras mutation and LOH test (Table 2).
|Histopathology||< 192 ng/ml||>=192 ng/ml||Negative||Positive||Negative||Positive|