Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts

Muriel Genevay, Mari Mino-Kenudson, Kurt Yaeger, Ioannis T. Konstantinidis, Cristina R. Ferrone, Sarah Thayer, Carlos Fernandez Del Castillo, Dushyant Sahani, Brenna Bounds, David Forcione, William R. Brugge, Martha Bishop Pitman

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Abstract

OBJECTIVE:: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND:: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage. METHODS:: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated. RESULTS:: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features. CONCLUSIONS:: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN. Copyright C

Original languageEnglish (US)
Pages (from-to)977-983
Number of pages7
JournalAnnals of surgery
Volume254
Issue number6
DOIs
StatePublished - Dec 1 2011

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Pancreatic Cyst
Cell Biology
Pancreatic Ducts
Cysts
Neoplasms
Guidelines
Christianity
Triage
Carcinoma in Situ
Pancreas
Epithelial Cells

ASJC Scopus subject areas

  • Surgery

Cite this

Genevay, M., Mino-Kenudson, M., Yaeger, K., Konstantinidis, I. T., Ferrone, C. R., Thayer, S., ... Pitman, M. B. (2011). Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. Annals of surgery, 254(6), 977-983. https://doi.org/10.1097/SLA.0b013e3182383118

Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. / Genevay, Muriel; Mino-Kenudson, Mari; Yaeger, Kurt; Konstantinidis, Ioannis T.; Ferrone, Cristina R.; Thayer, Sarah; Castillo, Carlos Fernandez Del; Sahani, Dushyant; Bounds, Brenna; Forcione, David; Brugge, William R.; Pitman, Martha Bishop.

In: Annals of surgery, Vol. 254, No. 6, 01.12.2011, p. 977-983.

Research output: Contribution to journalArticle

Genevay, M, Mino-Kenudson, M, Yaeger, K, Konstantinidis, IT, Ferrone, CR, Thayer, S, Castillo, CFD, Sahani, D, Bounds, B, Forcione, D, Brugge, WR & Pitman, MB 2011, 'Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts', Annals of surgery, vol. 254, no. 6, pp. 977-983. https://doi.org/10.1097/SLA.0b013e3182383118
Genevay, Muriel ; Mino-Kenudson, Mari ; Yaeger, Kurt ; Konstantinidis, Ioannis T. ; Ferrone, Cristina R. ; Thayer, Sarah ; Castillo, Carlos Fernandez Del ; Sahani, Dushyant ; Bounds, Brenna ; Forcione, David ; Brugge, William R. ; Pitman, Martha Bishop. / Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. In: Annals of surgery. 2011 ; Vol. 254, No. 6. pp. 977-983.
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abstract = "OBJECTIVE:: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND:: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and {"}positive{"} cytology as high risk stigmata for malignancy warranting surgical triage. METHODS:: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated. RESULTS:: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72{\%}) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67{\%}), whereas also being specific (85 and 88{\%}, respectively). MN and dilated MPD were highly specific (>90{\%}), but insensitive (39{\%}-44{\%}). Cytology detected 30{\%} more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features. CONCLUSIONS:: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN. Copyright C",
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AU - Genevay, Muriel

AU - Mino-Kenudson, Mari

AU - Yaeger, Kurt

AU - Konstantinidis, Ioannis T.

AU - Ferrone, Cristina R.

AU - Thayer, Sarah

AU - Castillo, Carlos Fernandez Del

AU - Sahani, Dushyant

AU - Bounds, Brenna

AU - Forcione, David

AU - Brugge, William R.

AU - Pitman, Martha Bishop

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N2 - OBJECTIVE:: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND:: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage. METHODS:: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated. RESULTS:: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features. CONCLUSIONS:: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN. Copyright C

AB - OBJECTIVE:: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND:: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage. METHODS:: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated. RESULTS:: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features. CONCLUSIONS:: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN. Copyright C

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