Role of biochemistry and cytological analysis of cyst fluid for the differential diagnosis of pancreatic cysts

Soyer, Özlem Mutluay; Baran, Bülent; Örmeci, Aslı; Şahin, Davut; Göktürk, Suut; Evirgen, Sami; Başar, Rafet; Firat, Pınar; Akyüz, Filiz; Demır, Kadir; Beşışık, Fatih; Kaymakoğlu, Sabahattin; Karaca, Çetin

doi:10.1097/md.0000000000005513

Cited by 18 publications

(14 citation statements)

References 29 publications

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“…In addition, Ki-67 labeling indices may be evaluated to grade NETs in EUS-FNA aspirates. Although less frequently performed to diagnose ductal adenocarcinomas, immunohistochemical stains for p53 (overexpression or complete loss of expression), SMAD4 (loss of expression), and carcinoembryonic antigen (cytoplasmic expression) are useful in the differential diagnosis between ductal adenocarcinomas and benign reactive epithelial cells [ 11 , 20 ]. Fluorescence in situ hybridization for loss or alterations in copy number of 9p21, 3, 7, and 17 improves sensitivity for diagnosing ductal adenocarcinoma [ 21 ].…”

Section: What Ancillary Tests Can Be Applied To Endoscopic Ultrasoundmentioning

confidence: 99%

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions

Kim

Jang

2020

J Pathol Transl Med

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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology/biopsy is currently performed at many institutions and has become a routine procedure for pathologic diagnosis of pancreatic lesions. Although endoscopic ultrasound scanning began in the early 1980s [1], it has gained widespread popularity since the introduction of fine needle aspiration cytology/biopsy devices, which allow guided biopsies of target lesions visualized by endoscopic ultrasound [2]. Before the era of EUS-FNA, it was difficult to target pancreatic lesions due to limited accessibility by percutaneous needle biopsies. Hence, pathologists could rarely encounter cytology and/or biopsy material from pancreatic lesions. With the increasing popularity of EUS-FNA procedures, interpretation of EUS-FNA cytology/biopsy material has become an almost inevitable part of routine practice for pathologic diagnosis of various pancreatic lesions. A main concern of pancreatic EUS-FNA specimen interpretation is the limited amount of aspirated material. Compared to aspirated material from superficial organs, such as the thyroid, breast, or uterine cervix, EUS-FNA from pancreatic lesions provides aspirates with relatively limited cellularity that may seem inadequate to less experienced pathologists. However, EUS-FNA inevitably results in lower cellularity compared to aspirates from other superficial organs. To make an appropriate diagnosis, pathologists should consider the clinical impression, especially radiologic and/or EUS findings; otherwise, many EUS-FNA specimens may be interpreted as "inadequate specimen". It is occasionally necessary to deem the sample "inadequate", "atypical", or of "uncertain malignant potential", which are diagnostically less useful to clinicians, but necessary. The use of these indeterminate categories will be reduced with expertise and correlation of cytologic

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Section: What Ancillary Tests Can Be Applied To Endoscopic Ultrasoundmentioning

confidence: 99%

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions

Kim

Jang

2020

J Pathol Transl Med

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“…There is no gold standard test for pancreatic cystic lesions. However, imaging findings, clinical history, and cystic fluid cytopathological and biochemical analyses may be of help in differential diagnosis [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Cystic fluid neutrophil gelatinase-associated lipocalin (NGAL) concentration in differential diagnosis of pancreatic cystic lesions: a new factor enters the scene?

Lipiński

Degowska

Rydzewska

2018

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IntroductionNeutrophil gelatinase-associated lipocalin – 25 kDa peptide – is at present one of the most fascinating and unrecognised proteins implicated in the process of tumour development. Precise assessment of pancreatic cystic lesions is crucial for selecting available treatment options, such as conservative therapy or surgical resection.AimTo determine the utility of NGAL concentration in cyst fluid obtained by endoscopic ultrasound (EUS) with EUS-guided fine-needle aspiration (EUS-FNA) to distinguish neoplastic pancreatic cysts from pseudocysts.Material and methodsTwenty-two patients underwent EUS and FNA of a pancreatic cystic lesion; 9 of these patients underwent surgical resection, providing a histologic diagnosis of the cystic lesion. Furthermore, the final diagnosis was based on cyst fluid cytology, cyst fluid tumour markers (CEA, CA 72-4, CA 19-9), and medical history. Patients were divided in two groups: cystic neoplasms and inflammatory cysts (pseudocysts).ResultsThe final diagnosis was pseudocyst in 7 patients, serous cystadenoma in 4, mucinous cystadenoma in 3, intraductal papillary mucinous neoplasms in 6 patients, and cystic form of pancreatic adenocarcinoma in 2. Cyst fluid analysis of these patients showed that median cyst fluid NGAL for the cystic neoplasm group (211 ng/ml; n = 15) was significantly lower (p = 0.02) than the inflammatory cystic group (4689 ng/ml; n = 7). Correlation analysis showed that only fluid CA 72-4 was positively related to NGAL (r = 0.8, p < 0.01).ConclusionsIn this single-centre study, pancreatic cyst fluid NGAL concentration appeared to be useful in distinguishing neoplastic pancreatic cysts from pseudocysts. Larger studies are recommended to evaluate this role further.

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“…CEA levels may be used to distinguish between mucinous and non-mucinous cysts [29]. A CEA level of >192 µg/l has been shown to be accurate with a sensitivity and specificity of 52-78% and 63-91%, respectively.…”

Section: Biomarkers In Blood and Cyst Fluidmentioning

confidence: 99%

Pancreatic Cystic Neoplasms: Different Types, Different Management, New Guidelines

et al. 2018

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Pancreatic cystic neoplasms (PCN) include different types of cysts with various biological behavior. The most prevalent PCN are intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN). Management of PCN should focus on the prevention of malignant progression, while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated multidisciplinary PCN teams. The malignant potential of PCN varies enormously between the various types of PCN. A combination of computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, and endoscopic ultrasound with or without fine needle aspiration is typically needed before a reliable diagnosis can be made. Several guidelines discuss the management of PCN; however, most of these are non-evidence-based without clear consensus on the optimal treatment and follow-up strategy. The 2018 European guidelines on PCN are the first evidence-based guidelines to include IPMN, MCN, SCN, and all other PCN. This guideline advises a more conservative approach to side-branch IPMN and MCN smaller than 40 mm and more often a surgical approach in IPMN with a main duct dilatation beyond 5 mm. The goal of this review is to summarize the different types and management of the most common PCN based on the current literature and guidelines.

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Role of biochemistry and cytological analysis of cyst fluid for the differential diagnosis of pancreatic cysts

Cited by 18 publications

References 29 publications

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions

Cystic fluid neutrophil gelatinase-associated lipocalin (NGAL) concentration in differential diagnosis of pancreatic cystic lesions: a new factor enters the scene?

Pancreatic Cystic Neoplasms: Different Types, Different Management, New Guidelines

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