Abstract：
BACKGROUND: Fine-needle aspiration (FNA) diagnosis of pancreatic serous cystadenoma (SCA) remains challenging. This retrospective study aimed to evaluate the roles of cyst fluid ancillary testing and combined fine-needle biopsy (FNB) in improving the diagnostic yield.
METHODS: The authors retrospectively reviewed cytology cases that were histologically confirmed SCAs. Clinical features and FNA cyst fluid biochemical and molecular analysis results along FNB findings were reviewed.
RESULTS: The study cohort included 31 cases from 13 male and 18 female patients with a mean age of 65. The original cytologic diagnoses were nondiagnostic (n = 6, 19%), negative for malignant cells/cyst contents (n = 7, 23%), atypical cells (n = 3, 10%), nonmucinous cyst (n = 11, 35%), and serous cystadenoma (n = 4, 13%). Cyst fluid carcinoembryonic antigen (CEA) analysis was performed in 17 cases, all of which showed a low CEA level (<192 ng/mL). All 14 cases with molecular testing showed a wild-type KRAS. Inhibin immunohistochemistry was retrospectively performed on the FNA cell blocks, inhibin was positive in six of seven cases tested. In 15 cases with concurrent FNA and FNB biopsies, the diagnosis of SCA was seen in only one FNA case (7%) but 13 FNB cases (87%).
CONCLUSIONS: This study suggests that FNA diagnosis of SCA remains challenging even with ancillary testing including cyst fluid CEA level and KRAS mutation analysis. Adjunct inhibin immunostaining may help improve the cytologic diagnosis of selective SCA cases. FNB appears superior to FNA for a definite diagnosis of SCA.
METHODS: The authors retrospectively reviewed cytology cases that were histologically confirmed SCAs. Clinical features and FNA cyst fluid biochemical and molecular analysis results along FNB findings were reviewed.
RESULTS: The study cohort included 31 cases from 13 male and 18 female patients with a mean age of 65. The original cytologic diagnoses were nondiagnostic (n = 6, 19%), negative for malignant cells/cyst contents (n = 7, 23%), atypical cells (n = 3, 10%), nonmucinous cyst (n = 11, 35%), and serous cystadenoma (n = 4, 13%). Cyst fluid carcinoembryonic antigen (CEA) analysis was performed in 17 cases, all of which showed a low CEA level (<192 ng/mL). All 14 cases with molecular testing showed a wild-type KRAS. Inhibin immunohistochemistry was retrospectively performed on the FNA cell blocks, inhibin was positive in six of seven cases tested. In 15 cases with concurrent FNA and FNB biopsies, the diagnosis of SCA was seen in only one FNA case (7%) but 13 FNB cases (87%).
CONCLUSIONS: This study suggests that FNA diagnosis of SCA remains challenging even with ancillary testing including cyst fluid CEA level and KRAS mutation analysis. Adjunct inhibin immunostaining may help improve the cytologic diagnosis of selective SCA cases. FNB appears superior to FNA for a definite diagnosis of SCA.
摘要：
背景：胰腺浆液性囊腺瘤（SCA）的细针穿刺（FNA）诊断仍然具有挑战性。这项回顾性研究旨在评估囊肿液辅助检查和联合细针活检（FNB）在提高诊断率方面的作用。
方法：作者回顾性回顾了经组织学证实的SCAs的细胞学病例。回顾了FNB发现的临床特征以及FNA囊肿液生化和分子分析结果。
结果：研究队列包括31例患者，其中13例男性和18例女性患者，平均年龄为65岁。最初的细胞学诊断为非诊断性（n=6，19％），恶性细胞/囊肿内容物阴性（n=7，23%），非典型细胞（n=3，10%），非粘液性囊肿（n=11，35%），和浆液性囊腺瘤（n=4，13％）。对17例患者进行了囊肿液癌胚抗原（CEA）分析，所有这些都显示较低的CEA水平(<192ng/mL)。所有14例分子检测显示为野生型KRAS。对FNA细胞块进行抑制素免疫组织化学，7例检测中6例抑制素呈阳性。在15例同时进行FNA和FNB活检的病例中，SCA的诊断仅见于1例FNA(7%)和13例FNB(87%)。
结论：这项研究表明，即使采用包括囊液CEA水平和KRAS突变分析在内的辅助检测，SCA的FNA诊断仍具有挑战性。辅助抑制素免疫染色可能有助于改善选择性SCA病例的细胞学诊断。对于SCA的明确诊断，FNB似乎优于FNA。
方法：作者回顾性回顾了经组织学证实的SCAs的细胞学病例。回顾了FNB发现的临床特征以及FNA囊肿液生化和分子分析结果。
结果：研究队列包括31例患者，其中13例男性和18例女性患者，平均年龄为65岁。最初的细胞学诊断为非诊断性（n=6，19％），恶性细胞/囊肿内容物阴性（n=7，23%），非典型细胞（n=3，10%），非粘液性囊肿（n=11，35%），和浆液性囊腺瘤（n=4，13％）。对17例患者进行了囊肿液癌胚抗原（CEA）分析，所有这些都显示较低的CEA水平(<192ng/mL)。所有14例分子检测显示为野生型KRAS。对FNA细胞块进行抑制素免疫组织化学，7例检测中6例抑制素呈阳性。在15例同时进行FNA和FNB活检的病例中，SCA的诊断仅见于1例FNA(7%)和13例FNB(87%)。
结论：这项研究表明，即使采用包括囊液CEA水平和KRAS突变分析在内的辅助检测，SCA的FNA诊断仍具有挑战性。辅助抑制素免疫染色可能有助于改善选择性SCA病例的细胞学诊断。对于SCA的明确诊断，FNB似乎优于FNA。
