Department of Pathology, The James Homer Wright Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Ann Surg. 2011 Dec;254(6):977-83. doi: 10.1097/SLA.0b013e3182383118.
Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines.
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.
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.
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.
Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.
根据《仙台指南》定义，评估细胞学相对于影像学特征在恶性风险评估中的价值。
《仙台指南》列出了症状、囊肿大小>30mm、主胰管（MPD）扩张>6mm、壁结节（MN）和“阳性”细胞学作为恶性肿瘤的高危标志，需要手术分诊。
我们回顾了在一家三级医学中心评估的 112 例经组织学证实的胰腺黏液性囊肿的临床、放射学和细胞学数据。细胞学切片被盲目重新审查，上皮细胞分为良性或高级别不典型增生（HGA）[≥高级别异型增生]。组织学上，肿瘤分为良性（低级别和中级别异型增生）和恶性（原位和浸润性癌）。评估细胞学相对于其他危险因素的性能特征。
MPD 扩张、MN 和 HGA 是恶性肿瘤的独立预测因素（p<0.0001），但不是症状（p=0.29）或囊肿大小>30mm（p=0.51）。HGA 是所有囊肿（72%）和小（≤30mm）分支胰管内乳头状黏液性肿瘤（BD IPMN；67%）恶性肿瘤的最敏感预测因子，同时也具有特异性（分别为 85%和 88%）。MN 和 MPD 扩张具有高度特异性（>90%），但不敏感（39%-44%）。细胞学在小囊肿中比 MPD 扩张或 MN 检测到 30%更多的癌症，并且在没有这些高危影像学特征的一半癌症中也检测到癌症。
细胞学增加了对黏液性囊肿恶性预测的影像学评估的价值，特别是在小的 BD IPMN 中。
