Affiliation:
1. Department of Pathology and Laboratory Medicine Memorial Sloan Kettering Cancer Center New York New York USA
2. Division of General Internal Medicine Icahn School of Medicine at Mount Sinai New York New York USA
3. Department of Pathology Baylor College of Medicine Houston Texas USA
4. Department of Pathology and Laboratory Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx New York USA
5. Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
6. Department of Surgery Memorial Sloan Kettering Cancer Center New York New York USA
7. Department of Pathology and Laboratory Medicine Weill Cornell Medicine New York New York USA
Abstract
AbstractBackgroundPancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low‐ and high‐grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison.MethodsHistologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low‐ and high‐grade MN. A test for greater than or equal to four of eight high‐grade features (three‐dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high‐grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high‐risk clinical features are described.ResultsEndoscopic ultrasound fine‐needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low‐grade = 69, 62%; high‐grade = 24, 21%; and invasive = 19, 17%) and mucinous cystic neoplasms (low‐grade = 20, 90%; high‐grade = 2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid‐like (40% vs. 6%, p < .01), covered >20% of the smear area (32% vs. none, p < .01), and contained histiocytes (46% vs. 18%, p = .04). Greater than or equal to four of eight select high‐grade features was present in 36% of high‐grade MN with sensitivity 37% and 98% specificity.ConclusionColloid‐like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high‐grade features had low sensitivity and high specificity for high‐grade MN.