TY - JOUR
T1 - Diagnostic features of low- and high-grade mucinous neoplasms in pancreatic cyst FNA cytology
AU - Sigel, Carlie
AU - Wei, Xiao Jun
AU - Agaram, Narasimhan
AU - Sigel, Keith
AU - Raza, Roshan
AU - Andrade, Rebecca
AU - Rao, Rema
AU - Shah, Pari
AU - Soares, Kevin
AU - Goyal, Abha
N1 - Publisher Copyright:
© 2023 American Cancer Society.
PY - 2023/5
Y1 - 2023/5
N2 - Background: Pancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low- and high-grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison. Methods: Histologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low- and high-grade MN. A test for greater than or equal to four of eight high-grade features (three-dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high-grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high-risk clinical features are described. Results: Endoscopic ultrasound fine-needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low-grade = 69, 62%; high-grade = 24, 21%; and invasive = 19, 17%) and mucinous cystic neoplasms (low-grade = 20, 90%; high-grade = 2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid-like (40% vs. 6%, p <.01), covered >20% of the smear area (32% vs. none, p <.01), and contained histiocytes (46% vs. 18%, p =.04). Greater than or equal to four of eight select high-grade features was present in 36% of high-grade MN with sensitivity 37% and 98% specificity. Conclusion: Colloid-like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high-grade features had low sensitivity and high specificity for high-grade MN.
AB - Background: Pancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low- and high-grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison. Methods: Histologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low- and high-grade MN. A test for greater than or equal to four of eight high-grade features (three-dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high-grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high-risk clinical features are described. Results: Endoscopic ultrasound fine-needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low-grade = 69, 62%; high-grade = 24, 21%; and invasive = 19, 17%) and mucinous cystic neoplasms (low-grade = 20, 90%; high-grade = 2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid-like (40% vs. 6%, p <.01), covered >20% of the smear area (32% vs. none, p <.01), and contained histiocytes (46% vs. 18%, p =.04). Greater than or equal to four of eight select high-grade features was present in 36% of high-grade MN with sensitivity 37% and 98% specificity. Conclusion: Colloid-like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high-grade features had low sensitivity and high specificity for high-grade MN.
KW - PSC classification
KW - cytology
KW - grading
KW - intraductal papillary mucinous neoplasm
KW - mucin
KW - mucinous cystic neoplasm
KW - pancreas
KW - serous cystadenoma
UR - http://www.scopus.com/inward/record.url?scp=85146319695&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85146319695&partnerID=8YFLogxK
U2 - 10.1002/cncy.22681
DO - 10.1002/cncy.22681
M3 - Article
C2 - 36650420
AN - SCOPUS:85146319695
SN - 1934-662X
VL - 131
SP - 325
EP - 336
JO - Cancer Cytopathology
JF - Cancer Cytopathology
IS - 5
ER -
