Annals of surgery · 2011
Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts.
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Genevay Muriel, Mino-Kenudson Mari, Yaeger Kurt, Konstantinidis Ioannis T, Ferrone Cristina R, Thayer Sarah, Castillo Carlos Fernandez-del, Sahani Dushyant, Bounds Brenna, Forcione David, Brugge William R, Pitman Martha Bishop
Аннотация
OBJECTIVE: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines.
BACKGROUND: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage.
METHODS: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [≥high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated.
RESULTS: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features.
CONCLUSIONS: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.
BACKGROUND: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage.
METHODS: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [≥high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated.
RESULTS: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features.
CONCLUSIONS: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.
Предметные рубрики MeSH
Adenocarcinoma, MucinousAgedBiopsy, Fine-NeedleCarcinoma in SituCarcinoma, Pancreatic DuctalCell Transformation, NeoplasticCohort StudiesCystadenocarcinoma, MucinousDiagnosis, DifferentialEndosonographyFemaleGuideline AdherenceHumansMagnetic Resonance ImagingMaleMiddle AgedNeoplasm InvasivenessPancreatic CystPancreatic DuctsPancreatic NeoplasmsRisk AssessmentSensitivity and SpecificityTomography, X-Ray ComputedUltrasonography, Interventional