Charitini Salla, Eleni Karvouni1, Ilias Nikas2, Aristidis Ikonomakis3, Panagiotis Konstantinou4, Ioannis Karoumpalis5, Athanasia Sepsa6, Kleio Papaparaskeva7, Maria Tsopanomichalou8, Despoina Georgiadou9, Akrivi Kostopoulou10, Gregory Tsiotos11, Stamatios Theocharis12, Theodoros N Sergentanis13, Ekaterini Politi14. 1. Department of Pathology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 2. School of Medicine, European University of Cyprus, Nicosia, Cyprus. 3. Department of Gastroenterology and. 4. Department of Pathology and Cytopathology, 251 Air Force Hospital. 5. Department of Gastroenterology, "G. Gennimatas" General Hospital. 6. Department of Pathology, Metropolitan Hospital. 7. Department of Pathology, Konstantopoulio Agia Olga General Hospital, Athens, Greece. 8. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 9. Institute of Liver Studies, King's College Hospital, London, UK. 10. Department of Pathology, "G. Gennimatas" General Hospital. 11. First Department of Surgery, Mitera Hospital. 12. First Department of Pathology. 13. Department of Hygiene, Epidemiology and Medical Statistics, and. 14. Department of Cytopathology, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
OBJECTIVES: This study aims to evaluate the performance of clinical, imaging, and cytopathological criteria in the identification of high-grade dysplasia/carcinoma (HGD/Ca) in pancreatic mucin-producing cystic neoplasms. METHODS: Sixty-eight consecutive, histopathologically confirmed mucin-producing cystic neoplasms, evaluated by endoscopic ultrasound-guided fine-needle aspiration, were enrolled; specifically, 39 branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), 21 main duct IPMNs, and 8 mucinous cystic neoplasms. The associations between HGD/Ca in histopathology and findings of endoscopic ultrasound and cytology, demographic, lifestyle, and clinical parameters were evaluated, separately in IPMNs and mucinous cystic neoplasms. RESULTS: Age 65 years or more was associated with HGD/Ca in IPMNs. In BD-IPMNs, cyst diameter 3 cm or greater (sensitivity, 68.8%; specificity, 65.2%), a mural nodule (sensitivity, 56.3%; specificity, 78.3%), main pancreatic duct diameter 5 to 9 mm (sensitivity, 50.0%; specificity, 87.0%), and suspicious cytology (sensitivity, 81.3%; specificity, 100%) signaled the presence of HGD/Ca. Similarly, in main duct IPMNs, suspicious cytology predicted HGD/Ca with high sensitivity (88.9%) and excellent specificity (100%). Regarding cytopathological criteria, in BD-IPMNs, HGD/Ca was associated with a high nuclear/cytoplasmic ratio, background necrosis, presence of papillary structures, hypochromatic nuclei, hyperchromatic nuclei, and major nuclear membrane irregularities (thickening and/or indentations). CONCLUSIONS: Clinical, imaging, and cytopathological criteria are useful in the identification of HGD/Ca in IPMNs.
OBJECTIVES: This study aims to evaluate the performance of clinical, imaging, and cytopathological criteria in the identification of high-grade dysplasia/carcinoma (HGD/Ca) in pancreatic mucin-producing cystic neoplasms. METHODS: Sixty-eight consecutive, histopathologically confirmed mucin-producing cystic neoplasms, evaluated by endoscopic ultrasound-guided fine-needle aspiration, were enrolled; specifically, 39 branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), 21 main duct IPMNs, and 8 mucinous cystic neoplasms. The associations between HGD/Ca in histopathology and findings of endoscopic ultrasound and cytology, demographic, lifestyle, and clinical parameters were evaluated, separately in IPMNs and mucinous cystic neoplasms. RESULTS: Age 65 years or more was associated with HGD/Ca in IPMNs. In BD-IPMNs, cyst diameter 3 cm or greater (sensitivity, 68.8%; specificity, 65.2%), a mural nodule (sensitivity, 56.3%; specificity, 78.3%), main pancreatic duct diameter 5 to 9 mm (sensitivity, 50.0%; specificity, 87.0%), and suspicious cytology (sensitivity, 81.3%; specificity, 100%) signaled the presence of HGD/Ca. Similarly, in main duct IPMNs, suspicious cytology predicted HGD/Ca with high sensitivity (88.9%) and excellent specificity (100%). Regarding cytopathological criteria, in BD-IPMNs, HGD/Ca was associated with a high nuclear/cytoplasmic ratio, background necrosis, presence of papillary structures, hypochromatic nuclei, hyperchromatic nuclei, and major nuclear membrane irregularities (thickening and/or indentations). CONCLUSIONS: Clinical, imaging, and cytopathological criteria are useful in the identification of HGD/Ca in IPMNs.