Cytology from Pancreatic Cysts Has Marginal Utility in Surgical Decision-Making
Cytology from Pancreatic Cysts Has Marginal Utility in Surgical Decision-Making
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DOI：
10.1245/s10434-008-0110-0
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发表时间：
2008-11-01
影响因子：
3.7
通讯作者：
Swanson, Richard S.
中科院分区：
文献类型：
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作者：
Maker, Ajay V.;Lee, Linda S.;Swanson, Richard S.
背景：胰腺囊性肿瘤的术前诊断是有问题的。我们评估了我们的经验，内镜超声（EUS），以确定实用程序的细针穿刺细胞学（FNAC）在外科decisionmaking.Methods：患者评价胰腺囊肿与EUS细针穿刺（FNA）从1996年3月至2003年10月。确定了接受术前EUS-FNA和胰腺切除术的患者。细针穿刺活检显示为粘液性囊性肿瘤（MCN），疑似瘤形成，或粘液性上皮/非典型细胞被归类为“令人担忧”。“没有恶性细胞的细胞学检查呈阴性。FNAC读取为不确定的，不典型的细胞，意义不明，或可能的污染是nondiagnosis.Results：95例EUS FNAC评价，29例进行切除。在最终病理学检查中，7/29处病变（24%）为恶性[2例神经内分泌肿瘤、3例腺癌、1例浸润性导管内乳头状黏液性肿瘤（IPMN）和1例转移性子宫肿瘤]，4/29处病变（14%）为良性（3例浆液性囊腺瘤和1例慢性胰腺炎），18/29处病变（62%）为癌前病变（10例MCN和8例IPMN）。7例患者有相关FNAC。所有7个窝藏恶性或癌前病变。9例患者FNAC阴性：3例（33%）为良性病变，6例（67%）为癌前病变。29例患者中有13例（45%）进行了非诊断性FNAC，其中12/13例（92%）存在恶性或癌前病变。敏感性，特异性，阳性预测值和阴性预测值分别为28%，100%，100%，和18%，respectively.Conclusion：进行非手术治疗的决定不应该是基于一个阴性或非诊断FNAC单独，作为67%的阴性和92%的非诊断标本与恶性或癌前病变。
Background: Preoperative diagnosis of pancreatic cystic neoplasms is problematic. We evaluated our experience with endoscopic ultrasound (EUS) to determine the utility of fine-needle aspiration cytology (FNAC) in surgical decision-making.Methods: Patients evaluated for pancreatic cysts with EUS fine-needle aspiration (FNA) from 3/1996-10/2003 were included. Patients undergoing both preoperative EUS-FNA and pancreatic resection were identified. FNAC read as a mucinous cystic neoplasm (MCN), suspicious for neoplasia, or mucinous epithelial/atypical cells were classified as "concerning." Cytology with no malignant cells was negative. FNAC read as indeterminate, atypical cells of undetermined significance, or possible contamination was nondiagnostic.Results: Of 95 patients evaluated with EUS FNAC, 29 underwent resection. On final pathology, 7/29 lesions (24%) were malignant [two neuroendocrine tumors, three adenocarcinomas, one invasive intraductal papillary mucinous neoplasm (IPMN), and one metastatic uterine tumor], 4/29 (14%) were benign (three serous cystadenomas and one chronic pancreatitis), and 18/29 (62%) were premalignant (ten MCNs and eight IPMNs). Seven patients had concerning FNAC. All seven harbored malignant or premalignant lesions. Nine patients had negative FNAC: three (33%) with benign lesions and six (67%) with premalignant lesions. Thirteen of the 29 patients (45%) had nondiagnostic FNAC with 12/13 (92%) harboring a malignant or premalignant lesion. Sensitivity, specificity, positive predictive value, and negative predictive value were 28%, 100%, 100%, and 18%, respectively.Conclusion: The decision to proceed with nonoperative management should not be based on a negative or nondiagnostic FNAC alone, as 67% of negative and 92% of nondiagnostic specimens were associated with malignant or premalignant pathology.