Cytologic criteria to reduce error in EUS-FNA of solid pseudopapillary neoplasms of the pancreas

Hooper, Kari; Tracht, Jessica; Eldin-Eltoum, Isam A.

doi:10.1016/j.jasc.2017.06.002

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…Notably, the diagnosis of suspected SPNs based only on cytological findings without histopathological confirmation can misdiagnose np‐NETs as SPNs in up to 36% of the cases. Such misdiagnosis is commonly observed in clinical practice owing to considerable overlap between the radiological and even microscopic features of SPNs and np‐NETs 9,17 . Therefore, in addition to both cytological and histopathological evaluation, complementary IHC is widely recommended for the diagnosis of SPNs.…”

Section: Discussionmentioning

confidence: 99%

“…Considering its high diagnostic accuracy for the detection of ductal adenocarcinoma, 7 endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) could be a useful minimally invasive and reliable diagnostic modality for SPN. 2,8,9 We investigated the role of cell-blocks (CBs) and complementary immunohistochemistry (IHC) without cytological evaluation for the diagnosis of SPNs in specimens obtained by EUS-FNA.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, histopathological evaluation of suspicious lesions is necessary. Considering its high diagnostic accuracy for the detection of ductal adenocarcinoma, 7 endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (FNA) could be a useful minimally invasive and reliable diagnostic modality for SPN 2,8,9 …”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens

et al. 2020

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Introduction: Preoperative diagnostic imaging of pancreatic solid pseudopapillary neoplasms (SPNs) is challenging. A few studies have investigated the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of SPN. We investigated the diagnostic yield of cell-blocks and immunohistochemistry (IHC) for SPN using EUS-FNA specimens without cytological evaluation. Patients and methods: We retrospectively analysed the histopathology records of patients with suspected SPN, who underwent EUS-FNA biopsy between January 1997 and January 2020. Diagnosis based on cell-blocks (haematoxylin-eosin staining with complementary IHC) was compared with the definitive surgical diagnosis. Results: This study included 25 patients (24 were women). Patients' mean age was 33.7 years (range 12-78 years). The most common symptom was abdominal pain. SPN was an incidental finding in 52% of the patients. The mean lesion size was 4.3 cm (range 1.2-11.4 cm), and the most common endosonographic features included solidcystic (56%) or solid (40%) tumours. Final diagnoses included SPNs (n = 23) and nonfunctioning neuroendocrine tumours (n = 2). The overall accuracy of EUS-FNA was 80%. Tumour cells showed immunopositivity for β-catenin, CD10, CD99 and progesterone receptor (PR) in 93.7%, 87.5%, 83.3% and 66.6% of patients, respectively. No SPN showed immunopositivity for chromogranin A. Conclusions: Intention-to-diagnose analysis showed that the diagnostic accuracy of EUS-FNA for SPNs using cell blocks and complementary IHC without cytological evaluation was fairly good. Evaluation of β-catenin, CD 10, CD99 and PR expression must be included in the IHC panel for diagnostic confirmation of SPNs using EUS-FNA biopsy specimens.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens

et al. 2020

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“…However, the distinction between SPNPs and NETs may also represent a diagnostic challenge in cytological FNA evaluation. Awareness of the cytological features and appropriate use of immunohistochemical stains can prevent diagnostic errors [ 20 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Solid Pseudopapillary Neoplasm of the Pancreas: A Clinicopathological Study of 12 Cases With Emphasis on Diagnostic Pitfalls

Meliti,

Al-Maghrabi

2023

Cureus

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Introduction: Solid pseudopapillary neoplasm of the pancreas (SPNP) is a rare primary neoplasm with distinct clinicopathological features. The tumor most commonly occurs in younger (premenopausal) women and is typified by low malignant potential and an excellent overall prognosis. Methods: A retrospective search over 20 years at two referral tertiary care institutions (King Faisal Hospital and Research Center and King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia) revealed 12 female patients diagnosed with SPNPs. The reslts of ancillary studies performed at the time of diagnosis were also reviewed and placed in the context of current recommendations. Results: The clinical and pathological findings were reviewed. All patients were females, aged 18 to 30 years. Eight patients presented with abdominal pain, of which two experienced significant weight loss, and four presented with abdominal mass/discomfort. The tumor size ranged from 1.5 and 15 cm. Two cases were initially diagnosed as neuroendocrine tumors (NETs). One of the cases presented as a multifocal disease. All patients were treated surgically with a follow-up period between one and 11 years. Only one patient presented with peritoneal metastasis after seven years of follow-up, but generally, all are doing well. Conclusions: We have analyzed 12 SPNP cases in our population over 20 years (2001-2021) in this study. In brief, SPNP is a low-grade malignant potential tumor. Even though SPNP is a recognized entity, diagnostic challenges can arise particularly in the setting of limited sampling. Pathologists must be aware of the classic morphological features of SPNP and the characteristic profile of immunohistochemistry and be able to differentiate SPNP from other mimickers, especially well-differentiated NETs of the pancreas, and ultimately to avoid misdiagnosis and unnecessary oncologic treatment. Adequate surgical resection with negative margins is associated with an excellent outcome.

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“…Endosonography (EUS) is increasingly being used in the evaluation of pancreatic tumors. Recently, some studies evaluated the role in EUS-FNA in SPN [7][8][9][10][11][12], as well as comparing it with CT [13] and MRI for diagnosis, but its accuracy in SPN diagnosis remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Multicenter Study on the Diagnostic of Imaging Tests and EUS-guided fine needle aspiration of Solid Pseudopapillary Neoplasms of the Pancreas

Ricardo

Marchetti

Almeida

et al. 2021

Preprint

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Purpose Imaging diagnosis of SPN is difficult. Preoperative diagnosis by EUS-FNA) is possible, safe, and has been reported in the literature. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA and imaging findings in CT and MRI/MRCP exams in the diagnosis of patients with SPN. Methods We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected diagnosis of SPN on imaging studies in 5 high-volume hospitals. The final diagnosis was obtained after the histological examination of the surgical specimen. Demographic data, CT, MRI and EUS findings, anatomopathological specimen and McH results obtained by EUS were analyzed. Results Fifty-four patients were included, of which 49 (90.7%) were women with an average age of 33.4 (range 11–78) years. The most common symptom presented was abdominal pain, present in 35.2%. SPN was detected incidentally in 32 (59%). The mean size of the tumors was 3.8 cm (SD: 2.26). The most common findings at EUS were a solid, solid/cystic, and cystic lesion in 52.9%, 41.1% and 7.8%, respectively. The final diagnosis was SPN in 51 patients and NF-NET in 3. The correct diagnosis was made by CT, MRI, EUS and EUS-FNA in 21.9%, 28.9%, 64.7% and 88.2%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance to 94.11% and 94.11%, respectively. Conclusion Differential diagnosis between SPN and NF-NET with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in such cases and should be routinely used to rule out NF-NET.

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Cytologic criteria to reduce error in EUS-FNA of solid pseudopapillary neoplasms of the pancreas

Cited by 6 publications

References 20 publications

Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens

Diagnosis of pancreatic solid pseudopapillary neoplasms using cell‐blocks and immunohistochemical evaluation of endoscopic ultrasound‐guided fine needle aspiration biopsy specimens

Solid Pseudopapillary Neoplasm of the Pancreas: A Clinicopathological Study of 12 Cases With Emphasis on Diagnostic Pitfalls

Multicenter Study on the Diagnostic of Imaging Tests and EUS-guided fine needle aspiration of Solid Pseudopapillary Neoplasms of the Pancreas

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