Improving diagnostic yield of pancreatic serous cystadenoma with cyst fluid ancillary testing, adjunct immunohistochemistry, and additional fine-needle biopsy sampling

IF 2.6 3区医学 Q3 ONCOLOGY

Cancer Cytopathology Pub Date : 2024-03-07 DOI:10.1002/cncy.22808

Xi Wang MD, PhD, Xuchen Zhang MD, PhD, Pei Hui MD, PhD, Guoping Cai MD

{"title":"Improving diagnostic yield of pancreatic serous cystadenoma with cyst fluid ancillary testing, adjunct immunohistochemistry, and additional fine-needle biopsy sampling","authors":"Xi Wang MD, PhD, Xuchen Zhang MD, PhD, Pei Hui MD, PhD, Guoping Cai MD","doi":"10.1002/cncy.22808","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Fine-needle aspiration (FNA) diagnosis of pancreatic serous cystadenoma (SCA) remains challenging. This retrospective study aimed to evaluate the roles of cyst fluid ancillary testing and combined fine-needle biopsy (FNB) in improving the diagnostic yield.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>The authors retrospectively reviewed cytology cases that were histologically confirmed SCAs. Clinical features and FNA cyst fluid biochemical and molecular analysis results along FNB findings were reviewed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The study cohort included 31 cases from 13 male and 18 female patients with a mean age of 65. The original cytologic diagnoses were nondiagnostic (<i>n</i> = 6, 19%), negative for malignant cells/cyst contents (<i>n</i> = 7, 23%), atypical cells (<i>n</i> = 3, 10%), nonmucinous cyst (<i>n</i> = 11, 35%), and serous cystadenoma (<i>n</i> = 4, 13%). Cyst fluid carcinoembryonic antigen (CEA) analysis was performed in 17 cases, all of which showed a low CEA level (<192 ng/mL). All 14 cases with molecular testing showed a wild-type <i>KRAS</i>. Inhibin immunohistochemistry was retrospectively performed on the FNA cell blocks, inhibin was positive in six of seven cases tested. In 15 cases with concurrent FNA and FNB biopsies, the diagnosis of SCA was seen in only one FNA case (7%) but 13 FNB cases (87%).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study suggests that FNA diagnosis of SCA remains challenging even with ancillary testing including cyst fluid CEA level and <i>KRAS</i> mutation analysis. Adjunct inhibin immunostaining may help improve the cytologic diagnosis of selective SCA cases. FNB appears superior to FNA for a definite diagnosis of SCA.</p>\n </section>\n </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 7","pages":"425-434"},"PeriodicalIF":2.6000,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Cytopathology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cncy.22808","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Fine-needle aspiration (FNA) diagnosis of pancreatic serous cystadenoma (SCA) remains challenging. This retrospective study aimed to evaluate the roles of cyst fluid ancillary testing and combined fine-needle biopsy (FNB) in improving the diagnostic yield.

Methods

The authors retrospectively reviewed cytology cases that were histologically confirmed SCAs. Clinical features and FNA cyst fluid biochemical and molecular analysis results along FNB findings were reviewed.

Results

The study cohort included 31 cases from 13 male and 18 female patients with a mean age of 65. The original cytologic diagnoses were nondiagnostic (n = 6, 19%), negative for malignant cells/cyst contents (n = 7, 23%), atypical cells (n = 3, 10%), nonmucinous cyst (n = 11, 35%), and serous cystadenoma (n = 4, 13%). Cyst fluid carcinoembryonic antigen (CEA) analysis was performed in 17 cases, all of which showed a low CEA level (<192 ng/mL). All 14 cases with molecular testing showed a wild-type KRAS. Inhibin immunohistochemistry was retrospectively performed on the FNA cell blocks, inhibin was positive in six of seven cases tested. In 15 cases with concurrent FNA and FNB biopsies, the diagnosis of SCA was seen in only one FNA case (7%) but 13 FNB cases (87%).

Conclusions

This study suggests that FNA diagnosis of SCA remains challenging even with ancillary testing including cyst fluid CEA level and KRAS mutation analysis. Adjunct inhibin immunostaining may help improve the cytologic diagnosis of selective SCA cases. FNB appears superior to FNA for a definite diagnosis of SCA.

查看原文本刊更多论文

通过囊液辅助检测、辅助免疫组化和额外的细针活检取样，提高胰腺浆液性囊腺瘤的诊断率。

背景：胰腺浆液性囊腺瘤（SCA）的细针穿刺（FNA）诊断仍具有挑战性。这项回顾性研究旨在评估囊液辅助检查和联合细针活检（FNB）在提高诊断率方面的作用：作者回顾性分析了细胞学病例，这些病例经组织学证实为SCA。方法：作者回顾性分析了经组织学确诊的 SCA 细胞学病例，回顾了临床特征、FNA 囊液生化和分子分析结果以及 FNB 结果：研究队列包括来自 13 名男性和 18 名女性患者的 31 例病例，平均年龄为 65 岁。最初的细胞学诊断为无诊断性（6 例，19%）、恶性细胞/囊内容物阴性（7 例，23%）、非典型细胞（3 例，10%）、非粘液性囊肿（11 例，35%）和浆液性囊腺瘤（4 例，13%）。对17例患者的囊液进行了癌胚抗原（CEA）分析，结果显示所有患者的CEA水平均较低（结论：FNA诊断为非粘液性囊肿的几率很小：本研究表明，即使进行了包括囊液癌胚抗原水平和 KRAS 基因突变分析在内的辅助检测，FNA 诊断 SCA 仍具有挑战性。辅助抑制素免疫染色可能有助于改善选择性 SCA 病例的细胞学诊断。在明确诊断 SCA 方面，FNB 似乎优于 FNA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancer Cytopathology 医学-病理学

CiteScore

7.00

自引率

17.60%

发文量

130

审稿时长

1 months

期刊介绍： Cancer Cytopathology provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines. The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content. The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.