Diagnostic accuracy and risk stratification of pancreatic cyst fluids diagnosed as mucinous neoplasms without mucinous epithelium

IF 3.2 3区医学 Q3 ONCOLOGY

Cancer Cytopathology Pub Date : 2025-07-10 DOI:10.1002/cncy.70030

Priscila Dias Goncalves MD, M. Lisa Zhang MD

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引用次数: 0

Abstract

Introduction

Neoplastic mucinous cysts (NMC) are premalignant lesions that can be diagnosed on pancreatic cyst fluid (PCF) based on elevated carcinoembryonic antigen or thick extracellular mucin (ECM) without mucinous epithelium. Under the World Health Organization classification, such cases are considered “pancreaticobiliary neoplasm, low-risk/grade.” This study evaluates the diagnostic accuracy and risk of cysts diagnosed as NMC without mucinous epithelium.

Materials and methods

A total of 609 PCF specimens (493 patients) diagnosed as NMC were identified; 279/609 (45.8%) had no mucinous epithelium: 182 and 61 were diagnosed based only on elevated carcinoembryonic antigen ≥192 ng/mL or ECM, respectively.

Results

Among PCF without mucinous epithelium and with molecular correlation, 110/165 (66.7%) harbored KRAS/GNAS/RNF43 mutations. High-risk mutations (TP53/CDKN2A/SMAD4) occurred at similar rates in cysts with low-grade mucinous epithelium as in those without mucinous epithelium (6.5% vs. 3.6%, p = .224). A total of 63/71 (88.7%) resections from cysts without mucinous epithelium were confirmed as NMC: 40 (56.3%) had low-grade dysplasia and 23 (32.4%) had at least high-grade dysplasia. A total of 142/279 (50.9%) PCF without mucinous epithelium were molecularly or histologically confirmed as NMC. No significant differences were found in the rates of new worrisome radiologic features, invasive carcinoma, or disease-related mortality between the groups. Patient survival trended lower in the cohort with mucinous epithelium, though rates were comparable upon subanalysis of only “pancreaticobiliary neoplasm, low-risk/grade” cysts.

Conclusions

Even though PCF diagnosed as NMC without mucinous epithelium defaults to a low-risk category, the rates of high-grade neoplasia/high-risk outcomes are comparable to those with low-grade mucinous epithelium, supporting continued utility of carcinoembryonic antigen and ECM as diagnostic criteria for NMC in the absence of mucinous epithelium.

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无黏液上皮胰腺囊肿液诊断为黏液性肿瘤的诊断准确性和风险分层

肿瘤黏液囊肿（NMC）是一种癌前病变，可以在胰腺囊肿液（PCF）上诊断，基于癌胚抗原升高或无黏液上皮的厚细胞外黏液（ECM）。根据世界卫生组织的分类，这类病例被认为是“低风险/分级的胰胆管肿瘤”。本研究评估诊断为无黏液上皮的NMC囊肿的诊断准确性和风险。材料与方法诊断为NMC的PCF标本共609份（493例）；279/609例（45.8%）无粘液上皮，182例和61例分别仅根据癌胚抗原≥192 ng/mL升高或ECM诊断。结果在无黏液上皮且分子相关的PCF中，110/165（66.7%）存在KRAS/GNAS/RNF43突变。高风险突变（TP53/CDKN2A/SMAD4）在低级别黏液上皮囊肿和无黏液上皮囊肿中的发生率相似（6.5% vs. 3.6%, p = 0.224）。63/71例（88.7%）无黏液上皮囊肿切除术被证实为NMC: 40例（56.3%）为低级别非典型增生，23例（32.4%）为至少高级别非典型增生。142/279例（50.9%）无黏液上皮的PCF在分子或组织学上被证实为NMC。两组之间在新的令人担忧的放射学特征、浸润性癌或疾病相关死亡率方面没有发现显著差异。粘液上皮组患者的生存率较低，但在仅“胰胆管肿瘤，低风险/分级”囊肿的亚分析中，生存率相当。尽管诊断为无粘液上皮NMC的PCF默认为低风险类别，但高级别瘤变/高风险结局的发生率与低级别粘液上皮相当，这支持了癌胚抗原和ECM作为无粘液上皮NMC的诊断标准的继续应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.