Division of Endoscopy, Chiba Cancer Center, Chiba, Japan.
Ann Surg. 2013 Jun;257(6):1103-11. doi: 10.1097/SLA.0b013e318281b824.
To prospectively evaluate the diagnostic value of preoperative histological subtyping of intraductal papillary mucinous neoplasms (IPMNs) by pancreatic juice cytology (PJC) with mucin (MUC) stain.
IPMNs are classified into four subtypes based on their histomorphology and mucin phenotype, and varied degrees of malignant nature and prognosis among these subtypes have been shown.
The subjects were 36 patients with surgically confirmed IPMNs, who underwent PJC preoperatively by endoscopic retrograde cholangiopancreatography. Histological subtyping of cytological samples with or without MUC stain (MUC1, MUC2, and MUC5AC) was compared with that of resected specimens.
Histologically, low-grade dysplasia was found in 4 patients, intermediate in 10, high grade in 11, and invasive carcinoma in 11. Gastric, intestinal, pancreatobiliary, and oncocytic subtypes corresponded to 16, 14, 5, and 1 patient, respectively. The rate of high-grade dysplasia (HGD) and/or invasive IPMNs was 25% for gastric subtype, 85.7% for intestinal subtype, and 100% for both pancreatobiliary and oncocytic subtypes, showing a significant correlation between histological subtype and rate of HGD and/or invasive IPMN (P < 0.01 for gastric vs nongastric).Histological subtype was successfully diagnosed by PJC in 42% (15/36) without MUC stain, and the rate was significantly improved to 89% (32/36) with MUC stain (P < 0.01). The sensitivity, specificity, and overall accuracy of PJC with MUC stain were 86%, 100%, and 94% for intestinal subtype, respectively. When cytological grade was combined with MUC stain, the diagnosis of HGD/invasive IPMN showed 77.2% sensitivity, 85.7% specificity, and 80.5% accuracy.
Preoperative PJC with MUC stain proved to be highly reliable for identifying the histological subtype of IPMN and may provide useful information for deciding surgical indication.
前瞻性评估胰液细胞学（PJC）黏液（MUC）染色对术前胰管内乳头状黏液性肿瘤（IPMN）组织学分型的诊断价值。
根据其组织形态学和黏蛋白表型，IPMN 分为四型，这些亚型之间存在不同程度的恶性程度和预后。
对 36 例经手术证实的 IPMN 患者，经内镜逆行胰胆管造影术行术前 PJC。比较有或无 MUC 染色（MUC1、MUC2 和 MUC5AC）的细胞学样本的组织学分型与切除标本的组织学分型。
组织学上，4 例为低级别异型增生，10 例为中级别异型增生，11 例为高级别异型增生，11 例为浸润性癌。胃型、肠型、胰胆型和嗜酸细胞型分别对应 16、14、5 和 1 例患者。胃型的高级别异型增生（HGD）和/或浸润性 IPMN 发生率为 25%，肠型为 85.7%，胰胆型和嗜酸细胞型均为 100%，组织学分型与 HGD 和/或浸润性 IPMN 发生率之间存在显著相关性（胃型与非胃型比较，P<0.01）。不进行 MUC 染色，PJC 成功诊断组织学分型的比例为 42%（15/36），而进行 MUC 染色的比例显著提高至 89%（32/36）（P<0.01）。肠型 PJC 联合 MUC 染色的灵敏度、特异性和总准确率分别为 86%、100%和 94%。当细胞学分级与 MUC 染色相结合时，HGD/浸润性 IPMN 的诊断灵敏度为 77.2%，特异性为 85.7%，准确性为 80.5%。
术前 PJC 联合 MUC 染色对识别 IPMN 的组织学分型具有高度可靠性，可为决定手术适应证提供有用信息。
