Cytology Adds Value to Imaging Studies for Risk Assessment of Malignancy in Pancreatic Mucinous Cysts

Autor: Kurt A. Yaeger, Cristina R. Ferrone, David G. Forcione, Martha B. Pitman, Mari Mino-Kenudson, William R. Brugge, Muriel Genevay, Sarah P. Thayer, Brenna C. Bounds, Ioannis Konstantinidis, Dushyant V. Sahani, Carlos Fernandez-del Castillo
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Male
Pathology
Pancreatic Neoplasms/pathology
viruses
ddc:616.07
Cystadenocarcinoma
Mucinous
Endosonography
Cystadenocarcinoma
Mucinous/pathology
Cohort Studies
Cytology
Cyst
Cystadenocarcinoma
Pancreatic Cyst/pathology
Middle Aged
Adenocarcinoma
Mucinous
Magnetic Resonance Imaging
medicine.anatomical_structure
Cell Transformation
Neoplastic
embryonic structures
Pancreatic Ducts/pathology
Adenocarcinoma
Female
Guideline Adherence
Carcinoma in Situ
Carcinoma
Pancreatic Ductal
medicine.medical_specialty
Cell Transformation
Neoplastic/pathology
Biopsy
Fine-Needle
Carcinoma
Pancreatic Ductal/pathology
Malignancy
Risk Assessment
Sensitivity and Specificity
Article
Diagnosis
Differential
medicine
Carcinoma
Humans
Neoplasm Invasiveness
Ultrasonography
Interventional
Aged
Pancreatic duct
Mural Nodule
Carcinoma in Situ/pathology
business.industry
Adenocarcinoma
Mucinous/pathology
Pancreatic Ducts
medicine.disease
Pancreatic Neoplasms
Surgery
Pancreatic Cyst
business
Tomography
X-Ray Computed
Zdroj: Annals of Surgery, Vol. 254, No 6 (2011) pp. 977-83
ISSN: 0003-4932
Popis: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines.The Sendai Guidelines list symptoms, cyst size30 mm, dilated main pancreatic duct (MPD)6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage.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.Dilated MPD, MN, and HGA were independent predictors of malignancy (p0.0001), but not symptoms (p = 0.29) or cyst size30 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.Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.
Databáze: OpenAIRE
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