Format

Send to:

Choose Destination
See comment in PubMed Commons below
Ann Surg. 2011 Dec;254(6):977-83. doi: 10.1097/SLA.0b013e3182383118.

Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts.

Author information

  • 1Department of Pathology, The James Homer Wright Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Abstract

OBJECTIVE:

Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines.

BACKGROUND:

The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage.

METHODS:

We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [≥high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated.

RESULTS:

Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features.

CONCLUSIONS:

Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.

PMID:
22041510
[PubMed - indexed for MEDLINE]
PMCID:
PMC3817564
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins Icon for PubMed Central
    Loading ...
    Write to the Help Desk