Feasibility and safety of microforceps biopsy in the diagnosis of pancreatic cysts

Published:March 03, 2018DOI:https://doi.org/10.1016/j.gie.2018.02.039

      Background and Aims

      The tissue acquisition and diagnostic yield of cyst fluid cytology is low-to-moderate and rarely provides a specific diagnosis. The aim of this study was to compare the tissue acquisition and diagnostic tissue yield of microforceps biopsy (MFB) with cyst fluid cytology.

      Methods

      In this multicenter study, data of 42 patients who had cysts both aspirated by EUS-guided FNA (EUS-FNA) and biopsy specimens were then obtained with an MFB device, were collected. Cytology analysis of cyst fluid and histologic analysis of biopsy specimens were done. Acquisition yield was defined as percentage of patients with tissue present in the aspirate or biopsy. Diagnostic tissue yield was evaluated at 3 levels: the ability of differentiation between mucinous and/or nonmucinous cysts, detection of high risk for malignancy, and specific cyst type diagnosis.

      Results

      The mean patient age was 69 years. Sixteen pancreatic cysts (38.1%) were located in the head, 17 (40.5%) in the body, and 9 (21.4%) in the tail. The mean cyst size was 28.2 mm (12-60 mm); 25 of 42 (60%) were septated. The EUS-FNA tissue (fluid) acquisition yield was 88.1% (37/42). The MFB tissue acquisition yield was 90.4% (38/42). The diagnostic cytology yield to differentiate between mucinous and/or nonmucinous cysts was 47.6% (20/42), and the MFB histologic yield to differentiate between mucinous and/or nonmucinous cysts was 61.9% (26/42) (P = .188). The percentage of cysts at high risk for malignancy by cytology was 54.7% (23/42), and MFB was 71.5% (30/42) (P = .113). However, the ability of MFB to provide a specific cyst type diagnosis was 35.7% (15/42), and that for cytology was 4.8% (2/42) (P = .001). Surgical histology was concordant with that of MFB in 6 of 7 patients (85%), and with that of cytology in 1 of 7 patients (15%).

      Conclusion

      The cyst tissue acquisition yield for MFBs was 90%. Although cytology of cyst fluid and MFB were comparable in distinguishing mucinous and nonmucinous cysts and detecting cysts at high risk for malignancy, MFB was far superior to cytology for providing a specific cyst diagnosis.

      Abbreviations:

      CEA (carcinoembryonic antigen), cPNET (cystic pancreatic neuroendocrine tumor), EUS-FNA (EUS-guided FNA), IPMN (intraductal papillary neoplasm), MCN (mucinous cystic neoplasm), MFB (microforceps biopsy)
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      References

        • Yoon W.J.
        • Brugge W.R.
        Pancreatic cystic neoplasms: diagnosis and management.
        Gastroenterol Clin North Am. 2012; 41: 103-118
        • Brugge W.R.
        Diagnosis and management of cystic lesions of the pancreas.
        J Gastrointest Oncol. 2015; 6: 375-388
        • Mortelé K.J.
        Cystic pancreatic neoplasms: imaging features and management strategy.
        Semin Roentgenol. 2013; 48: 253-263
        • Brugge W.R.
        The use of EUS to diagnose cystic neoplasms of the pancreas.
        Gastrointest Endosc. 2009; 69: S203-S209
        • Yoon W.J.
        • Brugge W.R.
        Endoscopic ultrasound and pancreatic cystic lesions-diagnostic and therapeutic applications.
        Endosc Ultrasound. 2012; 1: 75-79
        • Brugge W.R.
        • Lewandrowski K.
        • Lee-Lewandrowski E.
        • et al.
        Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.
        Gastroenterology. 2004; 126: 1330-1336
        • Cizginer S.
        • Turner B.G.
        • Bilge A.R.
        • et al.
        Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts.
        Pancreas. 2011; 40 ([published correction appears in Pancreas. 2013;42:728]): 1024-1028
        • Zhan X.B.
        • Wang B.
        • Liu F.
        • et al.
        Cyst fluid carcino embryonic antigen concentration and cytology by endosonography-guided fine needle aspiration in predicting malignant pancreatic mucinous cystic neoplasms.
        J Dig Dis. 2013; 14: 191-195
        • Pitman M.B.
        • Genevay M.
        • Yaeger K.
        • et al.
        High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology.
        Cancer Cytopathol. 2010; 118: 434-440
        • Springer S.
        • Wang Y.
        • Dal Molin M.
        • et al.
        A combination of molecular markers and clinical features improve the classification of pancreatic cysts.
        Gastroenterology. 2015; 149: 1501-1510
        • Pitman M.B.
        • Lewandrowski K.
        • Shen J.
        • et al.
        Pancreatic cysts: preoperative diagnosis and clinical management.
        Cancer Cytopathol. 2010; 118: 1-13
        • Pitman M.B.
        • Centeno B.A.
        • Daglilar E.S.
        • et al.
        Cytological criteria of high-grade epithelial atypia in the cyst fluid of pancreatic intraductal papillary mucinous neoplasms.
        Cancer Cytopathol. 2014; 122: 40-47
        • Morales-Oyarvide V.
        • Yoon W.J.
        • Ingkakul T.
        • et al.
        Cystic pancreatic neuroendocrine tumors: the value of cytology in pre-operative diagnosis.
        Cancer Cytopathology. 2014; 122: 435-444
        • Wani S.
        • Puli S.R.
        • Shaheen N.J.
        • et al.
        Esophageal adenocarcinoma in Barrett's esophagus after endoscopic ablative therapy: a meta-analysis and systematic review.
        Am J Gastroenterol. 2009; 104: 502-513
        • Ostör A.G.
        Natural history of cervical intraepithelial neoplasia: a critical review.
        Int J Gynecol Pathol. 1993; 12: 186-192
        • Schmidt C.M.
        Pancreatic cyst cytology: optimization of cancer risk profiling.
        Cancer Cytopathol. 2013; 121: 2-3
        • Pitman M.B.
        • Brugge W.R.
        • Warshaw A.L.
        The value of cyst fluid analysis in the pre-operative evaluation of pancreatic cysts.
        J Gastrointest Oncol. 2011; 2: 195-198
        • Brugge W.R.
        • De Witt J.
        • Klapman J.B.
        • et al.
        Techniques for cytologic sampling of pancreatic and bile duct lesions: The Papanicolaou Society of Cytopathology Guidelines.
        Cytojournal. 2014; 11: 2
        • Woolf K.M.
        • Liang H.
        • Sletten Z.J.
        • et al.
        False-negative rate of endoscopic ultrasound-guided fine-needle aspiration for pancreatic solid and cystic lesions with matched surgical resections as the gold standard: one institution's experience.
        Cancer Cytopathol. 2013; 121: 449-458
        • Belsley N.A.
        • Pitman M.B.
        • Lauwers G.Y.
        • et al.
        Serous cystadenomas of the pancreas: diagnostic performance of imaging and fine needle aspiration biopsy.
        Cancer Cytopathol. 2008; 114: 102-110
      1. Centeno BA, Stelow E, Pitman MB. Pancreatic cytohistology. Cytohistology of small tissue samples. Published in association with the Papanicolaou Society of Cytopathology. KR Geisinger, MB Pitman, series editors. Cambridge, UK: Cambridge University Press; 2015.

        • Adsay N.V.
        Cystic neoplasia of the pancreas: pathology and biology.
        J Gastrointest Surg. 2008; 12: 401-404
        • Chen A.L.
        • Misdraji J.
        • Brugge W.R.
        • et al.
        Acinar cell cystadenoma: a challenging cytology diagnosis, facilitated by moray(®) micro-forceps biopsy.
        Diagn Cytopathol. 2017; 45: 557-560
        • Scourtas A.
        • Dudley J.C.
        • Brugge W.R.
        • et al.
        Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms.
        Cancer. 2017; 125: 169-177