Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms

Scourtas, Aristana; Dudley, Jonathan C.; Brugge, William R.; Kadayıfçı, Abdurrahman; Mino‐Kenudson, Mari; Pitman, Martha B.

doi:10.1002/cncy.21806

Cited by 32 publications

(17 citation statements)

References 31 publications

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“…Cytology for PCN has a low sensitivity but a high specificity (see statement 3.5). 263 Low sensitivity and frequent non-diagnostic yield are mainly due to low cellularity of the aspirated fluid.…”

Section: Recommendationsmentioning

confidence: 99%

European evidence-based guidelines on pancreatic cystic neoplasms

2018

Gut

995

614

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Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

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Section: Recommendationsmentioning

confidence: 99%

European evidence-based guidelines on pancreatic cystic neoplasms

2018

Gut

995

614

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“…At the current time, PCF analysis at the Massachusetts General Hospital consists of cytology, biochemical analysis with carcinoembryonic antigen (CEA) and amylase levels, and molecular testing via next‐generation sequencing (NGS). Cyst fluid CEA (CEA ≥192 ng/mL) has been shown to be the most accurate method for identifying a mucinous cyst, whereas cytology is the best modality for identifying high‐risk cysts . With the addition of routine molecular analysis, in which KRAS/GNAS mutations are highly specific for a mucinous etiology, the detection of mucinous cysts by PCF is reported to have a sensitivity of 90% and a specificity >90% …”

Section: Introductionmentioning

confidence: 99%

Moray micro forceps biopsy improves the diagnosis of specific pancreatic cysts

Zhang

Arpin

Brugge

et al. 2018

Cancer Cytopathology

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“…Amylase in the cyst fluid would be consistent with ductal communication, and levels <250 U/L indicated lack of ductal communication with a specificity of 98% [28,29]. Low amylase, however, does not rule out malignancy [30]. CAE is an epithelial glycoprotein suggestive of mucin production [28].…”

Section: Single Marker Analysesmentioning

confidence: 99%

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

Hao

Takahashi

Snyder

et al. 2020

IJMS

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A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.

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Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms

Cited by 32 publications

References 31 publications

European evidence-based guidelines on pancreatic cystic neoplasms

European evidence-based guidelines on pancreatic cystic neoplasms

Moray micro forceps biopsy improves the diagnosis of specific pancreatic cysts

Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future

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