Diagnostic error assessment and associated harm of endoscopic ultrasound‐guided fine‐needle aspiration of neuroendocrine neoplasms of the pancreas

Abstract

BACKGROUND: Over the past decade, the standardization of error classification in anatomic pathology has become an important issue. The objective of the current study was to assess the extent of errors occurring in the cytopathologic diagnosis of neuroendocrine lesions of the pancreas, and to classify these errors and their associated harm. METHODS:Information on all cases diagnosed as a neuroendocrine neoplasm either by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in cytology or by surgical pathology between 2000 and 2012 was collected. Using standardized error and harm classification, the authors reviewed the cytology and surgical pathology material and evaluated the type and the cause of diagnostic errors and their impact on the patient. RESULTS: A total of 177 patients who underwent EUS-FNA were diagnosed with a neuroendocrine neoplasm either by cytology or surgical pathology. Eighty of these cases had surgical follow-up available at the study institution. Of these 80 cases, 56 had an adequate cell block and immunohistochemistry was performed. There were 14 discrepancies noted between cytologic and surgical pathologic diagnoses. There were 9 false-negative cases, consisting of 3 interpretation errors and 6 cytology sampling errors. There were 5 misclassifications, including 4 cases of solid pseudopapillary neoplasm and 1 case of neuroendocrine carcinoma (diagnosed as adenocarcinoma on cytology). There were no surgical pathology errors noted. All errors were associated with no or minor harm. CONCLUSIONS: EUS-FNA of pancreatic neuroendocrine neoplasms has excellent diagnostic performance, with no false-positive diagnoses reported. When an adequate sample is obtained, the most significant error is misclassification, which is most often associated with solid pseudopapillary neoplasm. The harm associated with diagnostic errors is at most minor. Cancer (Cancer Cytopathol) 2013;121:653-60.

CTNNB1 mutational analysis of solid-pseudopapillary neoplasms of the pancreas using endoscopic ultrasound-guided fine-needle aspiration and next-generation deep sequencing

“…SPNs show cytoplasmic and nuclear staining 3,7 , but PNETs show membranous staining. Accurate diagnosis of SPNs is sometimes difficult with EUS-FNA because of interpretative, sampling, and misclassification errors or insufficient material for immunostaining 19 . In the present study, 1 case of SPN could not be diagnosed pathologically on the basis of EUS-FNA samples.…”

“…SPNs could be seen as well-demarcated, hypoechoic, solid masses that sometimes coexist with cystic lesions and/or calcification on EUS. Accuracy of preoperative SPN diagnosis by EUS-FNA is reported to be 75-100% 17,18 ; however, diagnosis by EUS-FNA is sometimes difficult because of interpretative, sampling, and misclassification errors or insufficient material for immunostaining 19 . In addition, EUS-FNA samples sometimes contain tumor cells that are too small to use for sequencing analysis by polymerase chain reaction (PCR)-based direct sequencing.…”

Hyaline globules and papillary fragments in cytologic smears from two intra‐abdominal tumors (ovarian and hepatic) in female patients: A diagnostic pitfall with histologic correlation

“…The present study describes the cytological findings with histologic correlation of two tumors that can appear predominantly in young woman and share some cytologic and histologic similarities such as: papillary pattern, hyaline globules and intercellular basement membrane deposits …”

“…Solid pseudopapillary neoplasm of the pancreas (SPNP) is an infrequent tumor reported to account for <3% of all non‐endocrine pancreatic tumors . It frequently appears in young women, and due to its rare aggressive behavior it should be differentiated from other highly metastatic pancreatic neoplasms …”

Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms

“…The combination of dual-phase thin-section multidetector CT and EUS has been reported as the most accurate procedure to detect insulinomas [166]. EUS plus FNA is highly cost-effective when used early in the preoperative work-up, reducing the need for additional invasive tests [167, 168]; complication rate is quite low (<1 %) [168]. A close correlation between aspiration cytology and the final histology after resection has been demonstrated [169].…”