Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
Am J Surg Pathol. 2012 Oct;36(10):1434-43. doi: 10.1097/PAS.0b013e31825d534a.
The PathfinderTG biomarker panel is useful in the evaluation of pancreatic cysts that have clinical features suspicious for malignancy, but its utility in classifying fine-needle aspiration biopsies from small pancreatic cystic lesions is yet to be proven. We used morphology to classify 20 pancreatic cyst cytology aspirates, all of which met radiographic criteria for close observation. Cases were cytologically classified as consistent with pseudocyst, serous cystadenoma, or mucinous neoplasm with low-grade, intermediate-grade, or high-grade dysplasia and analyzed for carcinoembryonic antigen. Redpath Integrated Pathology Inc. rendered diagnoses of nonmucinous (reactive/indolent or serous) or mucinous (low-risk or at risk) cyst on the basis of results of the PathfinderTG panel (KRAS mutations, DNA content, and loss of heterozygosity at microsatellites linked to tumor suppressor genes). Cytologic and commercial laboratory diagnoses were concordant in only 7 (35%) cases. Seven cysts classified as mucinous with low-grade dysplasia by cytology were interpreted as nonmucinous on the basis of the PathfinderTG panel, 2 of which were resected mucinous cysts. Two pancreatitis-related pseudocysts were misdiagnosed as low-risk mucinous cysts; 1 mucinous cyst with low-grade dysplasia was considered at risk for neoplastic progression using the PathfinderTG panel. Only 1 cyst misclassified as pseudocyst by cytology, but low-risk mucinous cyst by molecular analysis, proved to be a mucinous cystic neoplasm with low-grade dysplasia after surgical resection. We conclude that the PathfinderTG panel may aid the classification of pancreatic lesions, but is often inaccurate and should not replace cytologic evaluation of these lesions.
探路者 TG 生物标志物面板在评估具有恶性临床特征的胰腺囊肿方面很有用，但它在对小胰腺囊性病变的细针抽吸活检进行分类方面的效用尚未得到证实。我们使用形态学对 20 例胰腺囊液细胞学抽吸物进行分类，所有这些抽吸物均符合放射影像学密切观察的标准。细胞学分类为假性囊肿、浆液性囊腺瘤或黏液性肿瘤，低级别、中级别或高级别异型增生，并分析癌胚抗原。Redpath Integrated Pathology Inc. 根据探路者 TG 面板（KRAS 突变、DNA 含量和与肿瘤抑制基因相关的微卫星杂合性丢失）的结果，对非黏液性（反应性/惰性或浆液性）或黏液性（低风险或有风险）囊肿做出诊断（非黏液性（反应性/惰性或浆液性）或黏液性（低风险或有风险）囊肿）。细胞学和商业实验室诊断仅在 7 例（35%）中一致。7 例细胞学诊断为低级别异型增生的黏液性囊肿，根据探路者 TG 面板结果判断为非黏液性，其中 2 例为切除的黏液性囊肿。2 例胰腺炎相关假性囊肿误诊为低风险黏液性囊肿；1 例低级别异型增生的黏液性囊肿，使用探路者 TG 面板被认为有肿瘤进展的风险。只有 1 例细胞学误诊为假性囊肿但分子分析为低风险黏液性囊肿的囊肿，在手术后被证实为低级别异型增生的黏液性囊性肿瘤。我们得出结论，探路者 TG 面板可能有助于胰腺病变的分类，但通常不准确，不应替代对这些病变的细胞学评估。
