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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pancreatic cystic neoplasms: diagnosis and management.Gastroenterol Clin North Am. 2012; 41: 103-118
- Diagnosis and management of cystic lesions of the pancreas.J Gastrointest Oncol. 2015; 6: 375-388
- Cystic pancreatic neoplasms: imaging features and management strategy.Semin Roentgenol. 2013; 48: 253-263
- The use of EUS to diagnose cystic neoplasms of the pancreas.Gastrointest Endosc. 2009; 69: S203-S209
- Endoscopic ultrasound and pancreatic cystic lesions-diagnostic and therapeutic applications.Endosc Ultrasound. 2012; 1: 75-79
- Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.Gastroenterology. 2004; 126: 1330-1336
- 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
- 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
- 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
- A combination of molecular markers and clinical features improve the classification of pancreatic cysts.Gastroenterology. 2015; 149: 1501-1510
- Pancreatic cysts: preoperative diagnosis and clinical management.Cancer Cytopathol. 2010; 118: 1-13
- Cytological criteria of high-grade epithelial atypia in the cyst fluid of pancreatic intraductal papillary mucinous neoplasms.Cancer Cytopathol. 2014; 122: 40-47
- Cystic pancreatic neuroendocrine tumors: the value of cytology in pre-operative diagnosis.Cancer Cytopathology. 2014; 122: 435-444
- Esophageal adenocarcinoma in Barrett's esophagus after endoscopic ablative therapy: a meta-analysis and systematic review.Am J Gastroenterol. 2009; 104: 502-513
- Natural history of cervical intraepithelial neoplasia: a critical review.Int J Gynecol Pathol. 1993; 12: 186-192
- Pancreatic cyst cytology: optimization of cancer risk profiling.Cancer Cytopathol. 2013; 121: 2-3
- The value of cyst fluid analysis in the pre-operative evaluation of pancreatic cysts.J Gastrointest Oncol. 2011; 2: 195-198
- Techniques for cytologic sampling of pancreatic and bile duct lesions: The Papanicolaou Society of Cytopathology Guidelines.Cytojournal. 2014; 11: 2
- 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
- Serous cystadenomas of the pancreas: diagnostic performance of imaging and fine needle aspiration biopsy.Cancer Cytopathol. 2008; 114: 102-110
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.
- Cystic neoplasia of the pancreas: pathology and biology.J Gastrointest Surg. 2008; 12: 401-404
- Acinar cell cystadenoma: a challenging cytology diagnosis, facilitated by moray(®) micro-forceps biopsy.Diagn Cytopathol. 2017; 45: 557-560
- Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms.Cancer. 2017; 125: 169-177
Article info
Publication history
Published online: March 03, 2018
Accepted:
February 20,
2018
Received:
September 22,
2017
Footnotes
DISCLOSURE: O. Basar has received a grant from U.S. Endoscopy Group, Inc. D. Yang is a consultant for US Endoscopy. J. Samarasena is a consultant for US Endoscopy. C. DiMaio is a consultant and speaker for Boston Scientific and Medtronic. M. Wagh is a consultant for Boston Scientific and Medtronic. K. Chang is a consultant for Olympus and Cook Medical and a speaker for Medtronic. W. Brugge does research for Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.
See CME section, p. 159.
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
